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1

Infection after arthroscopic anterior cruciate ligament reconstruction.  

PubMed

EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Identify the most common pathogen of infection after anterior cruciate ligament (ACL) reconstruction. 2. Outline the general principles for the treatment of infection after ACL reconstruction. 3. Determine the indications of graft excision and hardware removal. 4. Summarize the outcomes of infection after ACL reconstruction. Septic arthritis is a rare but potentially devastating complication of anterior cruciate ligament (ACL) reconstruction surgery. The purpose of this study was to provide an evidence-based summarization of the treatment and outcome of infection after ACL reconstruction with a pooled analysis of the reported cases. The authors conducted a systematic review of published studies that evaluated the outcome of septic arthritis after arthroscopic ACL reconstruction. A structured literature review of multiple databases referenced articles from 1950 to 2012. A total of 22,836 knees from 14 published studies were assessed. Postoperative septic arthritis occurred in 121 knees, with a pooled percentage of 0.5%. Mean duration of follow-up after ACL reconstruction was 53.6 months (range, 4-218 months). An average of 1.92 procedures (range, 1-5 procedures) were performed to eradicate the infection. The grafts were retained in 77% of cases. Postoperative intravenous antibiotics were used for at least 5 days (range, 5-90 days) after debridement. At final follow-up, mean postoperative Lysholm score was 80.2 (range, 23-100). No reinfection was observed in 121 patients. This study has helped to further elucidate the outcomes of infection after ACL reconstruction. Once an infection is encountered, culture-specific antibiotics and surgical joint irrigation with graft retention are recommended as initial treatment. Graft removal can be considered only for those infections resistant to initial treatment. [Orthopedics. 2014; 37(7):477-484.]. PMID:24992054

Kim, Seung-Ju; Postigo, Ricardo; Koo, Sowon; Kim, Jong Hun

2014-07-01

2

Displaced anterior cruciate ligament avulsion fractures: Arthroscopic staple fixation  

PubMed Central

Background: Anterior cruciate ligament (ACL) avulsion fracture is commonly associated with knee injuries and its management is controversial ranging from conservative treatment to arthroscopic fixation. The aim of our study was to assess the clinical and radiological results of arthroscopic staple fixation in the management of ACL avulsion fractures. Materials and Methods: Twenty-two patients (17 males and 5 females) who underwent arthroscopic staple fixation for displaced ACL avulsion fractures were analysed. The mean age was 32.2 years (15-55 years) with a mean followup of 21 months (6-36 months). All patients were assessed clinically by calculating their Lysholm and International Knee Documentation Committee (IKDC) scores and the radiological union was assessed in the followup radiographs. Results: The mean Lysholm score was 95.4(83-100) and the mean IKDC score was 91.1(77-100) at the final followup. In 20 patients anterior drawer's test was negative at the end of final followup while two patients had grade I laxity. Associated knee injuries were found in seven cases. The final outcome was not greatly influenced by the presence of associated injuries when treated simultaneously. At final followup all the patients were able to return to their pre-injury occupation Conclusion: Arthroscopic staple fixation is a safe and reliable method for producing clinical and radiological outcome in displaced ACL avulsion fractures.

Sundararajan, S R; Rajasekaran, S; Bernard, S Leo

2011-01-01

3

Arthroscopic removal of EndoButton after anterior cruciate ligament reconstruction: case report and surgical technique.  

PubMed

Multiple methods of anterior cruciate ligament reconstruction are in use, and femoral fixation has been much discussed. The EndoButton Continuous Loop (Smith & Nephew Endoscopy, Andover, Mass) fixation device has been shown to be efficacious and is in widespread use, but few complications have been reported. In this article, we describe the case of a properly positioned EndoButton that caused symptomatic extensor mechanism irritation necessitating arthroscopic removal. PMID:19212571

Petit, Charles; Millett, Peter J

2008-12-01

4

Arthrometric stability of horizontal versus vertical single-bundle arthroscopic anterior cruciate ligament reconstruction.  

PubMed

The anteroposterior (AP) stability of standard anterior cruciate ligament (ACL) reconstruction, referred to as "vertical," was compared with that of a modified femoral position, referred to as "horizontal," which is lower than and anterior to an operative knee at 90° flexion. Two consecutive series of 50 patients underwent vertical and horizontal arthroscopic single-bundle ACL reconstruction, respectively. For vertical reconstruction, the clock position was chosen, placing the graft at 10:30 in right knees and 1:30 in left knees, 1 to 2 mm anterior to the posterior femoral cortical cortex and at the back of the resident ridge. In the horizontal reconstruction, the transplant replaced the original ligament insertion at approximately the 9:30 o'clock position in right knees and the 2:30 o'clock position in left knees, approximately 2 mm in front of the posterior femoral cortical cortex. One year after surgery, the results of stabilometric evaluation revealed good performance after horizontal transplant. The mean clinical results changed from 1.0 (±1.3) mm for vertical to 0.7 (±1.3) mm for horizontal reconstruction. PMID:24810813

Denti, Matteo; Arrigoni, Paolo; Volpi, Piero; Bait, Corrado; Sedran, Jean Claude; Randelli, Pietro

2014-05-01

5

Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction.  

PubMed

The native anterior cruciate ligament (ACL) consists of 2 bundles, which have distinct biomechanical yet synergistic functions with respect to anterior tibial translation and combined rotatory loads. Traditionally, most ACL reconstruction techniques have primarily addressed the restoration of the anteromedial bundle, and less consideration was given to the posterolateral bundle. Recently, various ACL double-bundle reconstruction techniques have been described. With most of these techniques, however, an indirect extra-anatomic fixation far from the articular surface was performed. Because extra-anatomic fixation techniques, rather than aperture fixation techniques, are associated with graft tunnel motion, windshield wiper action, and suture stretch-out, concerns may arise regarding delayed biological incorporation, tunnel enlargement, and secondary rotational and anterior instability. We, therefore, present a novel arthroscopic technique that reapproximates the footprints of native ACL with the use of double-strand semitendinosus and gracilis autografts for reconstruction of the anteromedial and posterolateral bundles, respectively. A separate femoral and tibial tunnel is drilled for each double-strand autograft. The femoral tunnel for the anteromedial bundle is drilled primarily through a transtibial technique, and the femoral tunnel for the posterolateral bundle is drilled via an accessory anteromedial portal with the use of a 4-mm offset drill guide in the anteroinferior aspect of the femoral tunnel for the anteromedial bundle. Bioabsorbable interference screws are used in aperture fixation for anatomic fixation of each bundle. This technique attempts to reproduce closely the native ligament and its biomechanical function. PMID:17084308

Brucker, Peter U; Lorenz, Stephan; Imhoff, Andreas B

2006-11-01

6

A 7Year Follow-up of Patellar Tendon and Hamstring Tendon Grafts for Arthroscopic Anterior Cruciate Ligament ReconstructionDifferences and Similarities  

Microsoft Academic Search

Background: For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials.Hypothesis: There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years.Study Design: Cohort study; Level

Justin Roe; Leo A. Pinczewski; Vivianne J. Russell; Lucy J. Salmon; Tomomaro Kawamata; Melvin Chew

2005-01-01

7

Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft  

PubMed Central

Background Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction. Methods We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch. Conclusion Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.

2011-01-01

8

[Arthroscopic diagnostics and treatment for cysts of the anterior cruciate ligament].  

PubMed

From among over 500 knees examined arthroscopically in 5 cases operated on because of painful limitation of the range of motion besides an inveterate ACL injury a cyst located around injured fibers was found. Arthroscopic removal of the cyst rendered permanent improvement in all cases. No recurrence has occurred. PMID:7555350

Pawlas, R; Szlachta, Z

1994-01-01

9

Malignant fibrous histiocytoma of the distal femur after an arthroscopic anterior cruciate ligament reconstruction: A case report and a review of the literature  

PubMed Central

Background Malignant degeneration in association with orthopaedic implants is a known but rare complication. To our knowledge, no case of osseous malignant fibrous histiocytoma after anterior cruciate ligament reconstruction is reported in the literature. Case presentation We report a 29-year-old male Turkish patient who presented with severe pain in the operated knee joint 40 months after arthroscopic anterior cruciate ligament reconstruction. X-ray and MR imaging showed a large destructive tumor in the medial femoral condyle. Biopsy determined a malignant fibrous histiocytoma. After neoadjuvant chemotherapy, wide tumor resection and distal femur reconstruction with a silver-coated non-cemented tumor knee joint prosthesis was performed. Adjuvant chemotherapy was continued according to the EURAMOS 1 protocol. Conclusions Though secondary malignant degeneration after orthopaedic implants or prostheses is not very likely, the attending physician should take this into consideration, especially if symptoms worsen severely over a short period of time.

2010-01-01

10

Arthroscopic anterior cruciate ligament reconstruction with modified “wireless” cross-screw transfix femoral fixation  

Microsoft Academic Search

Among several graft fixation options in arthroscopic ACL reconstruction for hamstring tendons, transcondylar fixation has\\u000a been suggested to offer mechanical advantages compared to other femoral fixation systems. Blind nature of the procedure may\\u000a result in several complications including iliotibial band irritation syndrome, breakage of the bio absorbable cross-pin, stress\\u000a fracture of the femoral cortex, and more commonly intraoperative wire loop

Fereidoon M. Jaberi; Ali Haghighat; Zahra Babanezhad; Mehrad M. Jaberi

2010-01-01

11

Functional Outcome in Athletes at Five Years of Arthroscopic Anterior Cruciate Ligament Reconstruction  

PubMed Central

Introduction. The purpose of this study was to analyze the functional outcome in competitive level athletes at 5 years after ACL reconstruction with regard to return to sports and the factors or reasons in those who either stopped sports or showed a fall in their sporting levels. Methods. 48 competitive athletes who had undergone arthroscopic assisted ACL reconstruction with a minimum follow up of at least 5 years were successfully recalled and were analyzed. Results. 22 patients had returned to the preinjury levels of sports and 18 showed a decrease in their sporting levels. Of the 18 patients, 12 referred to fear of reinjuring the same or contra-lateral knee as the prime reason for the same while 6 patients reported persisting knee pain and instability as reasons for a fall in their sporting abilities. The difference in the scores of these groups was statistically significant. 8 patients out of the 48 had left sports completely due to reasons other than sports, even though they had good knee outcome scores. Conclusion. Fear of reinjury and psychosocial issues that are relevant to the social milieu of the athlete are very important and affect the overall results of the surgery with respect to return to sports.

Devgan, Ashish; Magu, N. K.; Siwach, R. C.; Rohilla, Rajesh; Sangwan, S. S.

2011-01-01

12

Arthroscopic combined medial and lateral meniscus transplantation after double-tunnel, double-bundle anterior cruciate ligament reconstruction in the same knee.  

PubMed

Meniscus transplantation in combination with anterior cruciate ligament (ACL) reconstruction has been used in the treatment of patients with meniscus and ACL deficiency. However, there have been no reports of arthroscopic surgery and the outcome of both medial and lateral meniscus allograft transplantation after double-tunnel, double-bundle ACL reconstruction. Herein, we report the case of a young male who received arthroscopic lateral and medial meniscectomy and ACL tibialis allograft reconstruction performed with the double-tunnel and double-bundle technique approximately 8 months after a knee injury. Approximately 4 months postoperatively he began to experience pain and weakness in the operated knee and subsequently underwent arthroscopic lateral and medial meniscus allograft transplantation in the same procedure. Second-look arthroscopy and magnetic resonance imaging revealed the meniscal allografts to have normal shape and the ACL grafts to be relatively intact at 18 and 30 months after surgery. His knee appeared stable and the range of motion was normal. Our hypothesis was that knee stability could reliably be restored with this combined procedure and the meniscal grafts and ACL graft could provide protection for each other. We suggest that medial and lateral meniscus allografts for one patient should be from the same donor. In the operation, attention must be paid to the direction of the bone tunnels used to fix the horns of the meniscal grafts to avoid communication with other tunnels in the tibial plateau. PMID:22560745

Zhang, Ya-Dong; Hou, Shu-Xun; Zhang, Yi-Chao; Luo, Dian-Zhong; Zhong, Hong-Bin; Zhang, Hong

2012-12-01

13

The Advantage of Arthroscopic Anterior Cruciate Ligament Reconstruction with Autograft from the Tendons of the Semitendinosus - Gracilis Muscles for the Recovery of the Stability of the Knee  

PubMed Central

ABSTRACT Anterior cruciate ligament (ACL) injuries remain a common orthopaedic disease, particularly in young adults. The treatment of choice for ACL injuries is ACL reconstruction (ligamentoplasty). ACL reconstruction is the surgical intervention used to replace the damaged ACL with a bone-patella tendon-bone (BTB) graft or with soft parts (semitendinosus – gracilis muscles (ST-G) – a method more frequently used nowadays). Materials and method: In the Clinic of Orthopedics and Traumatology of the University Emergency Hospital of Bucharest, during the period 01.01.2009 – 01.03.2011, a number of 37 arthroscopic ACL reconstructions with ST-G were studied, performed to treat ACL isolated injuries or injuries associated with complex trauma of the knee. Results: Clinical studies have shown that ACL reconstruction is highly superior to ACL repair (suturing). Arthroscopy was the main method of diagnosis in 28 cases, whereas the remaining ACL injuries were diagnosed using the MRI. Conclusions: The rehabilitation of the patients who underwent arthroscopic ACL reconstructions with ST-G was easier and faster in comparison with that following the surgical interventions performed with BTB graft during the previous years.

Cirstoiu, Catalin; Circota, Gheorghe; Panaitescu, Corina; Niculaita, Radu

2011-01-01

14

Bioengineered anterior cruciate ligament  

NASA Technical Reports Server (NTRS)

The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.

Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

2001-01-01

15

Gait and electromyographic analysis of anterior cruciate ligament deficient subjects  

Microsoft Academic Search

Some anterior cruciate ligament deficient (ACLD) patients can overcome passive sagittal joint laxity and maintain dynamic stability of the knee joint. Gait analysis with electromyographic (EMG) support was used in an attempt to identify mechanisms whereby ACLD individuals achieve this functional stability. A group of 18 patients with arthroscopically proven, unilateral, chronic (>6 months) ACLD had their gait assessed using

D. J. Beard; R. S. Soundarapandian; J. J. O'Connor; C. A. F. Dodd

1996-01-01

16

Mucoid degeneration of the anterior cruciate ligament.  

PubMed

Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. We report a case of a patient with mucoid degeneration of the ACL, presenting with posterior knee pain and no history of a major knee trauma. On clinical examination, the active range of motion showed a flexion deficit. The posterior knee pain was induced by passive hyperflexion of the knee. There was no evidence of ligamentary instability. MRI showed a diffuse thickening of the ACL with a nodular mass on the femoral insertion occupying the intercondylar notch, with increased signal intensity on both T1- and T2-weighted images. Arthroscopic evaluation showed a diffuse hypertrophy of the ACL, throughout the entire length of the posterolateral bundle (PLB). A yellowish homogenous mass on the femoral insertion of the ACL impinged on the posterior cruciate ligament (PCL) in flexion and occupied the entire intercondylar notch. We performed an arthroscopic debridement of the hypertrophied tissues as precisely as possible. This resulted in a nearly complete removal of the PLB and immediate relief of symptoms. Examination of knee stability after debridement showed a stable ACL. Arthroscopic debridement of the mucoid degeneration of the ACL proved to be a safe and effective method, without causing ligamentary instability in daily activities. PMID:19089409

Motmans, Robrecht; Verheyden, Frank

2009-07-01

17

Seating of TightRope RT Button Under Direct Arthroscopic Visualization in Anterior Cruciate Ligament Reconstruction to Prevent Potential Complications  

PubMed Central

The ACL TightRope RT (Arthrex, Naples, FL) is a recently introduced fixation device. The adjustable graft loop allows the surgeon some freedom in terms of the length of the femoral socket, eliminates the need for bothersome intraoperative calculations for selecting loop length, ensures that the socket is completely filled with graft, and provides the possibility of tensioning the graft even after graft fixation. However, the device can be associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. For example, in our experience, sometimes the button of the TightRope RT may not flip, may become jammed inside the femoral canal, or may flip in the substance of the vastus lateralis. To prevent this, we have introduced 2 additional steps in our procedure: (1) direct visualization of the TightRope RT button in the femoral socket with the arthroscope during its passage and (2) a controlled push directly on the button with the help of a guide pin. Thus proper seating of the button is ensured by direct visualization and the crucial push helps in flipping and seating of the button.

Nag, Hira L.; Gupta, Himanshu

2012-01-01

18

Individualized Anatomic Anterior Cruciate Ligament Reconstruction  

PubMed Central

Arthroscopic anterior cruciate ligament reconstruction (ACL-R) is a technique that continues to evolve. Good results have been established with respect to reducing anteroposterior laxity. However, these results have come into question because nonanatomic techniques have been ineffective at restoring knee kinematics and raised concerns that abnormal kinematics may impact long-term knee health. Anatomic ACL-R attempts to closely reproduce the patient's individual anatomic characteristics. Measurements of the patient's anatomy help determine graft choice and whether anatomic reconstruction should be performed with a single- or double-bundle technique. The bony landmarks and insertions of the anterior cruciate ligament (ACL) are preserved to assist with anatomic placement of both tibial and femoral tunnels. An anatomic single- or double-bundle reconstruction is performed with a goal of reproducing the characteristics of the native ACL. Long-term outcomes for anatomic ACL reconstruction are unknown. By individualizing ACL-R, we strive to reproduce the patient's native anatomy and restore knee kinematics to improve patient outcomes.

Rabuck, Stephen J.; Middleton, Kellie K.; Maeda, Shugo; Fujimaki, Yoshimasa; Muller, Bart; Araujo, Paulo H.; Fu, Freddie H.

2012-01-01

19

Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy  

Microsoft Academic Search

Fifty-four patients with anterior cruciate ligament tears that were arthroscopically reconstructed within 3 months of initial injury were prospectively evaluated. Patients with grade 3 medial collateral ligament, lateral collateral ligament, or posterior cruciate ligament tears were excluded. Eighty percent of our patients had a bone bruise present on the magnetic resonance image, with 68% in the lateral femoral condyle. Two

Kurt P. Spindler; Jean P. Schils; John A. Bergfeld; Jack T. Andrish; Garron G. Weiker; Thomas E. Anderson; David W. Piraino; Bradford J. Richmond; Sharon V. Medendorp

1993-01-01

20

Objective anterior cruciate ligament testing.  

PubMed

We examined subjects with the Stryker knee laxity tester as part of the clinical examination to determine its usefulness in evaluating the anterior cruciate ligament. We measured 123 athletes with no history of knee injury, as well as 30 patients with ACL injury proven by arthroscopy, and 11 injured patients with intact ACL at arthroscopy. We recorded anterior and posterior tibial displacement at 20 degrees of knee flexion and 20 lbs force in each direction. Anterior laxity and side to side difference correlated with ACL injury; posterior and total AP laxity did not. In normal subjects, mean anterior laxity was 2.5 mm. Only 8% of normal knees had anterior laxity of 5 mm or more. Ten percent of normal subjects had a side to side difference of 2 mm or more. In ACL tears, mean laxity was 8.1 mm, with 94% measuring 5 mm or more. Of the subjects, 89% with unilateral ACL injury had an increase of 2 mm or more on the injured side. Ten of ten acute ACL tears were detected by these criteria, with no false positives. In injured knees with intact ACL, measurements did not differ significantly from normal. We found the objective knee laxity measurement to be a useful complement to clinical knee examination. PMID:3960778

Boniface, R J; Fu, F H; Ilkhanipour, K

1986-03-01

21

Arthroscopic anatomical double-bundle anterior cruciate ligament reconstruction for asian patient using a bone-patellar tendon-bone and gracilis tendon composite autograft: a technical note  

PubMed Central

Background Recent years have seen anterior cruciate ligament (ACL) reconstruction being performed in a broad range of patients, regardless of age, sex and occupation, thanks to great advances in surgical techniques, surgical instruments and basic research. In cases of ACL reconstruction, bone-patellar tendon-bone (BTB) graft or hamstring graft are frequency used. However, potential complications associated with tunnel enlargement due to soft tissue graft such as hamstring were reported. On the other hand, an altered rotational axis resulting in significantly greater translation of the lateral compartment in the single bundle compared with double bundle ACL reconstruction was reported. Method and procedure A reconstruction procedure was modified for the ACL using a double bundle that is the combination of BTB and gracilis tendon composite autograft. Two tibial and two femoral bone tunnels are used to reconstruct two bundles of ACL; an anteromedial bundle (AMB) and a posterolateral bundle (PLB). The femoral bone tunnels are created just posterior to the resident's ridge. The tibial bone tunnels are created at the center of AM and PL tibial attachment, respectively. BTB is fixed in the AM tunnels produced on the anatomical points of tibia and femur. The gracilis graft is fixed in an anatomical PL tunnel produced. The mean width of BTB is 7 mm, since10 mm graft is sometimes not suitable for patients, especially small Asian people and females. For these patients, 10 mm graft is bigger than one third of patella tendon width. Conclusion The devised surgical procedure based on a combination of BTB and gracilis autograft is suitable reconstruction method for patients who have small or medium width of patellar tendon such as Asian people and females. This technique is also applicable to revision surgery.

2012-01-01

22

Anterior cruciate ligament tunnel placement.  

PubMed

The purpose of this cadaveric study was to analyze variation in anterior cruciate ligament (ACL) tunnel placement between surgeons and the influence of preferred surgical technique and surgeon experience level using three-dimensional (3D) computed tomography (CT). In this study, 12 surgeons drilled ACL tunnels on six cadaveric knees each. Surgeons were divided by experience level and preferred surgical technique (two-incision [TI], medial portal [MP], and transtibial [TT]). ACL tunnel aperture locations were analyzed using 3D CT scans and compared with radiographic ACL footprint criteria. The femoral tunnel location from front to back within the notch demonstrated a range of means of 16% with the TI tunnels the furthest back. A range of means of only 5% was found for femoral tunnel low to high positions by technique. The anterior to posterior tibial tunnel measure demonstrated wider variation than the medial to lateral position. The mean tibial tunnel location drilled by TT surgeons was more posterior than surgeons using the other techniques. Overall, 82% of femoral tunnels and 78% of tibial tunnels met all radiographic measurement criteria. Slight (1-7%) differences in mean tunnel placement on the femur and tibia were found between experienced and new surgeons. The location of the femoral tunnel aperture in the front to back plane relative to the notch roof and the anterior to posterior position on the tibia were the most variable measures. Surgeon experience level did not appear to significantly affect tunnel location. This study provides background information that may be beneficial when evaluating multisurgeon and multicenter collaborative ACL studies. PMID:24414390

Wolf, Brian R; Ramme, Austin J; Britton, Carla L; Amendola, Annunziato

2014-08-01

23

Medial meniscus anterior horn cyst: arthroscopic decompression  

Microsoft Academic Search

Meniscus cysts are mostly seen with meniscus tears, and arthroscopic decompression of cysts is gaining great importance in their treatment. In this study, we present a medial meniscus anterior horn cyst without an accompanying tear in the meniscus. A 33-year-old male patient was seen with pain and a palpable mass in his right knee. He complained that the severity of

R?fat Erginer; Tahir Ö?üt; Hayrettin Kesmezacar; Muharrem Babacan

2004-01-01

24

Remodeling of patellar tendon grafts augmented with woven polyester after anterior cruciate ligament reconstruction in humans  

Microsoft Academic Search

:   Arthroscopic and histological evaluations of anterior cruciate ligament (ACL) grafts were made in 38 patients at various\\u000a intervals after reconstruction was performed with patellar tendons (PTs) augmented with woven polyester. The interval between\\u000a the surgery and the examinations ranged from 3 to 36 months (mean, 14.1 months). Biopsy specimens with woven polyester were\\u000a removed from the anterior mid-portion of

Yoshihito Nakayama; Yasumasa Shirai; Tetsuya Narita; Atsushi Mori

1999-01-01

25

Longitudinal anterior knee laxity related to substantial tibial tunnel enlargement after anterior cruciate ligament revision.  

PubMed

Allograft and bioabsorbable screw use in anterior cruciate ligament (ACL) revision surgery is common. However, both allograft and bioabsorbable screws have been associated with immunologic reactions that lead to tunnel enlargement. Long-term studies examining tibial tunnel enlargement in this population are currently not available. We report a case of severe tibial and femoral tunnel enlargement 6.5 years after ACL revision surgery with anterior tibialis and semitendinosus allograft and bioabsorbable screw fixation. Longitudinal knee arthrometer data, knee examination with the patient under anesthesia, and arthroscopic inspection of the graft showed minimal effects of severe tunnel enlargement on anterior knee laxity and graft integrity. To our knowledge, this is the first case report of a longitudinal assessment of anterior knee laxity associated with severe tunnel enlargement. Surgeons should be aware of this condition and the clinical consequences that may accompany bone tunnel enlargement after ACL surgery. PMID:21802626

Quatman, Carmen E; Paterno, Mark V; Wordeman, Samuel C; Kaeding, Christopher C

2011-08-01

26

Graft healing in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation

Chih-Hwa Chen

2009-01-01

27

Septic arthritis following anterior cruciate ligament reconstruction secondary to Clostridium sporogenes; a rare clinical pathogen.  

PubMed

A case of septic arthritis post anterior cruciate ligament reconstruction secondary to Clostridium sporogenes is described in a 19-year-old man. C sporogenes is a rare clinical pathogen and this is believed to be the first case of septic arthritis due to the organism. The patient responded to arthroscopic washout, synovectomy and combination antibiotic therapy. A review of the literature is also presented. PMID:21278393

Inkster, Teresa; Cordina, Claire; Siegmeth, Alexander

2011-09-01

28

Abnormal femoral origin of the anterior cruciate ligament combined with a discoid lateral meniscus  

Microsoft Academic Search

This is a report on arthroscopic treatment of an abnormal femoral origin of the anterior cruciate ligament (ACL) in combination with a discoid lateral meniscus in a 3-year-old child. The discoid lateral meniscus was treated by resection of the inner part with punches and by use of the holmium:YAG laser. The abnormal femoral origin of the ACL which was found

Frank F. Hoffmann

1997-01-01

29

The O'Donoghue triad revisitedCombined knee injuries involving anterior cruciate and medial collateral ligament tears  

Microsoft Academic Search

We identified 60 consecutive patients with combined anterior cruciate and medial collateral ligament (ACL- MCL) disruptions that were incurred during athletic endeavors. Each underwent acute reconstruction of the ACL. The arthroscopic data obtained at the time of reconstructive surgery was reviewed in order to deter mine the incidence of O'Donoghue's triad (the \\

K. Donald Shelbourne; Paul A. Nitz

1991-01-01

30

Graft healing in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood\\u000a biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge\\u000a of this process have been made based primarly on animal models. According to the findings of this review, some surgical and\\u000a postoperative variables are known to

Max Ekdahl; James H.-C. Wang; Mario Ronga; Freddie H. Fu

2008-01-01

31

Proprioception in Anterior Cruciate Ligament-Deficient and Reconstructed Knees  

Microsoft Academic Search

Proprioceptive function of the knee was quantified and compared in three groups of patients: those with ante rior cruciate ligament deficiency, with hamstring ten dons-ligament augmentation device anterior cruciate ligament reconstructions, and with bone-patellar ten don-bone anterior cruciate ligament reconstructions. A total of 32 subjects, including 6 uninjured control sub jects, were tested for threshold to perception of passive motion

Peter B. MacDonald; David Hedden; Ondrej Pacin; Kelly Sutherland

1996-01-01

32

Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises In Vivo  

Microsoft Academic Search

Before studying the biomechanical effects of rehabili tation exercises on the reconstructed knee, it is impor tant to understand their effects on the normal anterior cruciate ligament. The objective of this investigation was to measure the strain behavior of this ligament dur ing rehabilitation activities in vivo. Participants were pa tient volunteers with normal anterior cruciate ligaments instrumented with the

Bruce D. Beynnon; Braden C. Fleming; Robert J. Johnson; Claude E. Nichols; Per A. Renström; Malcolm H. Pope

1995-01-01

33

The untreated anterior cruciate ligament rupture.  

PubMed

Forty-nine patients (52 knees) with untreated anterior cruciate ligament (ACL) ruptures were evaluated an average of 14 years after injury. The results were compared with those of a ten-year follow-up study on the same patients. Eighty-six percent of the knees had one or both menisci removed. There had been little change in symptoms, except that the incidence of giving way had decreased. The incidence of anterior laxity and rotary instability continued to be high. Seventy-five percent of the patients continued to participate in strenuous sports. The incidence of degenerative changes on roentgenograms had increased, with one-third of the knees demonstrating joint space narrowing or unequivocal evidence of osteoarthritis. Development of degenerative changes was associated with varus deformity, meniscectomy, and relatively heavy body weight. PMID:6821986

McDaniel, W J; Dameron, T B

1983-01-01

34

Risk Factors for Anterior Cruciate Ligament Injury  

PubMed Central

Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury.

Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

2012-01-01

35

Magnetic resonance imaging of anterior cruciate ligament tears: reevaluation of quantitative parameters and imaging findings including a simplified method for measuring the anterior cruciate ligament angle.  

PubMed

We evaluated the diagnostic utility of magnetic resonance imaging (MRI) for predicting anterior cruciate ligament (ACL) tears using both quantitative parameters and nonquantitative imaging findings. MRI examinations were retrospectively evaluated in a group of patients with arthroscopically confirmed complete ACL tear and in a control group with arthroscopically confirmed intact ACL. We evaluated multiple MRI features to compare their sensitivity and specificity for detecting ACL tears. Particular emphasis is put on the evaluation of three different quantitative parameters, including a simplified method for measuring the ACL angle. With a threshold value of 45 degrees the ACL angle reached a sensitivity and specificity of 100% for detecting ACL tears. With a threshold value of 0 degrees the Blumensaat angle had a sensitivity of 90% and a specificity of 98%. Finally, a threshold value of 115 degrees gave the posterior cruciate ligament angle a sensitivity of 70% and a specificity of 82%. Discontinuity was found to be the most useful of the ACL abnormalities. Of the secondary findings anterior tibial displacement was the best predictor of ligamentous injury. However, ACL abnormalities and secondary findings, alone or combined, failed to surpass the diagnostic value of the ACL angle for predicting ACL tears. Quantitative parameters are thus good predictors of ACL tears and may increase the overall sensitivity and specificity of MRI. The ACL angle may be confidently measured in a single MRI section and can be considered to be the most reliable quantitative parameter for detecting ACL tears. PMID:14530852

Mellado, J M; Calmet, J; Olona, M; Giné, J; Saurí, A

2004-05-01

36

[Manipulation and preparation of Achilles allograft for reconstruction of anterior and posterior cruciate ligament].  

PubMed

Cruciate ligament reconstruction surgery, both anterior and posterior, by arthroscopic technique is increasingly used today. We present the systematic handling and preparation of the Achilles allograft ligamentoplasty for use in anterior and posterior Cruciate ligaments performed by our team since 2000 in 45 cases. The use of tissues from tissue banks allows increasingly more difficult surgeries to be performed. The cases of reconstruction of anterior cruciate ligament are increasing due to the increased number of patients on whom the first step is performed. The reconstruction of posterior cruciate ligament is being performed in an increasing number of cases due to allografts being larger and thicker than autografts. The systematic management of grafts coming from tissue banks requires a systemic protocol for the safety of the receptor patient. All systematic handling and preparation of the Achilles allograft presented in this work is performed by the nurse-or-instrumentalist, not only in the management and safety of the grafts, but there is also a circulating nurse available in the background, who also is important. According to NIC the operations than can be performed by nursing are: * Surgical care. Definition: Assisting the surgeon in the operative procedure on the part of/the instrumentalist. * Surgical precautions. Definition: minimize the possibility of iatrogenic injury to the patient involved in a surgical procedure. PMID:20656538

Gimeno, Anna; Navarro, Jordi; Tejero, Paqui; Seijas, Roberto; Cuscó, Xavier; Ares, Oscar; Cugat, Ramón

2010-01-01

37

Current concept of partial anterior cruciate ligament ruptures.  

PubMed

A partial tear of the anterior cruciate ligament is a frequent pattern of ACL injury, observed in 10 to 27% of isolated ACL lesions. There are three reasons to preserve these remnants: biomechanical, vascular and proprioceptive advantages for the patient. Good quality fibers work as graft protection during the healing process. Periligamentous and endoligamentous vessels present into the native ACL tissue may enhance the vascularization of the ACL augmentation. Mechanoreceptors still remaining in the residual ACL fibers may have proprioceptive function. Definition is controversial, based on anatomy, on clinical examination, on instrumental laxity assessment or on MRI findings. Continuous remnant ACL fibers bridging the femur and tibia, from native femoral ACL footprint to native tibial ACL footprint seem to be a good definition. Diagnostic is suspected by accumulation of arguments brought by a thorough clinical examination, precise MRI analysis and examination under anesthesia. But the final diagnostic needs an arthroscopic evaluation to confirm the presence of fibers in good position and to validate its good mechanical properties. The treatment of ACL partial tear is a demanding surgery; difficulties to visualize the graft insertion site, especially on the femoral side, require a perfect knowledge of the normal anatomy of the native ACL footprint. Adapted portals, perfect controls of the tunnel drilling process, intercondylar notch space management are the keys of success. The pivot shift test under anesthesia, a hard stop Lachman test, MRI findings, level and type of sport, arthroscopic aspects of the remnants and its mechanical properties, allow the surgeon decide between non operative treatment, ACL augmentation or standard ACL reconstruction. PMID:21056025

Colombet, P; Dejour, D; Panisset, J-C; Siebold, R

2010-12-01

38

Current trends in anterior cruciate ligament reconstruction.  

PubMed

The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience. PMID:24368993

Kim, Ha Sung; Seon, Jong Keun; Jo, Ah Reum

2013-12-01

39

Anterior cruciate ligament tears in children.  

PubMed

Anterior cruciate ligament (ACL) injuries have become common in children and adolescents who practice competitive sports, accounting for 0.5-3% of all ACL injuries. Magnetic resonance imaging (MRI) is useful for diagnosis and treatment planning, but is no better than clinical examination, especially when the MRI is interpreted by less experienced health care professionals. Management of ACL deficiency in children is still controversial, but the present trend is towards early reconstruction, because repeated instability episodes may lead to secondary lesions of the knee, and induce meniscal tears and early degenerative alterations of the joint. Postoperatively, complications are rare, and most of the documented growth complications are secondary to avoidable technical errors such as placement of a fixation device across a growth plate. We recommend to reconstruct the ACL paying attention to avoid irreversible damage to the epiphyseal growth plates of the lower femur and upper tibia. PMID:22494779

Maffulli, Nicola; Del Buono, Angelo

2013-04-01

40

Current Trends in Anterior Cruciate Ligament Reconstruction  

PubMed Central

The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience.

Kim, Ha Sung; Jo, Ah Reum

2013-01-01

41

Anterior Cruciate Ligament Rupture and Osteoarthritis Progression  

PubMed Central

Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial. The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction. There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations.

Wong, James Min-Leong; Khan, Tanvir; Jayadev, Chethan S; Khan, Wasim; Johnstone, David

2012-01-01

42

Arthroscopic anterior cruciate ligament surgery: results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft five year follow-up of a prospective randomised controlled trial.  

PubMed

We conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). There were no significant differences between Lysholm or IKDC scores at any stage by 5 years. Significant differences were found between the groups at 2 years for Tegner activity scores, laxity and one-hop testing. By 5 years there were no significant differences. Clinical equivalence was demonstrated between the two groups for the Lysholm score and one-hop test but not for the Tegner activity score at 5 years. The use of the LK ligament has been largely abandoned due to reports of its insufficiency. Our results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present. PMID:19861236

Ghalayini, S R A; Helm, A T; Bonshahi, A Y; Lavender, A; Johnson, D S; Smith, R B

2010-10-01

43

Longitudinal Effects of Anterior Cruciate Ligament Injury and Patellar Tendon Autograft Reconstruction on Neuromuscular Performance  

Microsoft Academic Search

We examined persons after anterior cruciate ligament injury and for 1.5 years after anterior cruciate ligament reconstruction to analyze changes in anterior knee laxity, lower extremity muscle strength, endurance, and several parameters of neuromuscular function. Sixteen men and nine women (average age, 23.8 years) were evaluated preoperatively, then underwent intraarticular autogenous patellar tendon anterior cruciate ligament reconstruction by the same

Edward M. Wojtys; Laura J. Huston

2000-01-01

44

Joint hypermobility and anterior cruciate ligament injury.  

PubMed

PURPOSE. To compare the rates of joint hypermobility in patients with and without anterior cruciate ligament (ACL) injury. METHODS. Records of 135 men and 75 women (mean age, 24.6 years) who underwent ACL reconstructions were reviewed and compared with 55 male and 35 female controls with no knee injury. Joint hypermobility was evaluated by 2 examiners using the Beighton score. The maximum score was 9, and a score of 4 or greater was defined as hypermobility. RESULTS. The mean time from injury to presentation was 18 days. A non-contact mechanism of injury was more common. The inter-observer reliability was 0.7. 127 (60.5%) of the patients with ACL injury and 23 (25.5%) of the controls had hypermobility (p<0.01). Among them, 58% and 24% were men and 65% and 29% were women, respectively. Female gender was associated with hypermobility. Patients with ACL injury were more likely to have joint hypermobility with an odds ratio of 4.46. CONCLUSION. Joint hypermobility was more common in patients with ACL injury. PMID:24014780

Vaishya, Raju; Hasija, Rohit

2013-08-01

45

Anterior Cruciate Ligament Allograft Reconstruction in the Skeletally Immature Athlete  

Microsoft Academic Search

The purpose of this study was to evaluate anterior cru ciate ligament allograft reconstruction in skeletally im mature athletes. Eight patients (mean age, 13 years, 6 months; range, 10 to 15 years) with radiographic docu mentation of open growth plates had anterior cruciate ligament repair and reconstruction with fascia lata or Achilles tendon allograft tissue. A 7-mm graft was cen

Michelle Andrews; Frank R. Noyes; Sue D. Barber-Westin

1994-01-01

46

Arthroscopic Assessment of Stifle Synovitis in Dogs with Cranial Cruciate Ligament Rupture  

PubMed Central

Cranial cruciate ligament rupture (CR) is a degenerative condition in dogs that typically has a non-contact mechanism. Subsequent contralateral rupture often develops in dogs with unilateral CR. Synovitis severity is an important factor that promotes ligament degradation. Consequently, we wished to evaluate the utility of arthroscopy for assessment of stifle synovitis in dogs with CR. Herein, we report results of a prospective study of 27 dogs with unilateral CR and bilateral radiographic osteoarthritis. Arthroscopic images and synovial biopsies from the lateral and medial joint pouches were obtained bilaterally and graded for synovial hypertrophy, vascularity, and synovitis. Synovial tartrate-resistant acid phosphatase-positive (TRAP+) macrophages, CD3+ T lymphocytes, Factor VIII+ blood vessels, and synovial intima thickness were quantified histologically and related to arthroscopic observations. Risk of subsequent contralateral CR was examined using survival analysis. We found that arthroscopic scores were increased in the index stifle, compared with the contralateral stifle (p<0.05). Numbers of CD3+ T lymphocytes (SR?=?0.50, p<0.05) and TRAP+ cells in joint pouches (SR?=?0.59, p<0.01) were correlated between joint pairs. Arthroscopic grading of vascularity and synovitis was correlated with number density of Factor VIII+ vessels (SR>0.34, p<0.05). Arthroscopic grading of villus hypertrophy correlated with numbers of CD3+ T lymphocytes (SR?=?0.34, p<0.05). Synovial intima thickness was correlated with arthroscopic hypertrophy, vascularity, and synovitis (SR>0.31, p<0.05). Strong intra-observer and moderate inter-observer agreement for arthroscopic scoring was found. Dog age and arthroscopic vascularity significantly influenced risk of contralateral CR over time. We conclude that arthroscopic grading of synovitis is a precise tool that correlates with histologic synovitis. Arthroscopy is useful for assessment of stifle synovitis in client-owned dogs, and could be used in longitudinal clinical trials to monitor synovial responses to disease-modifying therapy.

Little, Jeffrey P.; Bleedorn, Jason A.; Sutherland, Brian J.; Sullivan, Ruth; Kalscheur, Vicki L.; Ramaker, Megan A.; Schaefer, Susan L.; Hao, Zhengling; Muir, Peter

2014-01-01

47

Rehabilitation After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background: Rigorous rehabilitation after anterior cruciate ligament (ACL) reconstruction is necessary for a successful surgical outcome. A large number of clinical trials continue to assess aspects of this rehabilitation process. Prior systematic reviews evaluated fifty-four Level-I and II clinical trials published through 2005. Methods: Eighty-five articles from 2006 to 2010 were identified utilizing multiple search engines. Twenty-nine Level-I or II studies met inclusion criteria and were evaluated with use of the CONSORT (Consolidated Standards of Reporting Trials) criteria. Topics included in this review are postoperative bracing, accelerated strengthening, home-based rehabilitation, proprioception and neuromuscular training, and six miscellaneous topics investigated in single trials. Results: Bracing following ACL reconstruction remains neither necessary nor beneficial and adds to the cost of the procedure. Early return to sports needs further research. Home-based rehabilitation can be successful. Although neuromuscular interventions are not likely to be harmful to patients, they are also not likely to yield large improvements in outcomes or help patients return to sports faster. Thus, they should not be performed to the exclusion of strengthening and range-of-motion exercises. Vibration training may lead to faster and more complete proprioceptive recovery but further evidence is needed. Conclusions: Several new modalities for rehabilitation after ACL reconstruction may be helpful but should not be performed to the exclusion of range-of-motion, strengthening, and functional exercises. Accelerated rehabilitation does not appear to be harmful but further investigation of rehabilitation timing is warranted. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Kruse, L.M.; Gray, B.; Wright, R.W.

2012-01-01

48

Arthroscopically assisted combined posterior cruciate ligament\\/posterior lateral complex reconstruction  

Microsoft Academic Search

This article presents the minimum 2-year results (range, 24 to 54 months) of 21 arthroscopically assisted posterior cruciate ligament\\/posterior lateral complex (PCL\\/PLC) reconstructions, evaluated preoperatively and postoperatively using the Tegner, Lysholm, and Hospital for Special Surgery knee ligament rating scales, and the KT 1000 knee ligament arthrometer (Medmetric Corp., San Diego, CA, U.S.A.). There were 15 male and 6 female

Gregory C. Fanelli; Bradley F. Giannotti; Craig J. Edson

1996-01-01

49

Arthroscopic posterior cruciate ligament reconstruction with bone-tendon-bone patellar graft  

Microsoft Academic Search

We present a retrospective study of 24 patients with chronic injury of the posterior cruciate ligament (PCL) treated by arthroscopically\\u000a assisted reconstruction with bone-tendon-bone patellar autograft. At a mean follow-up of 26.5 months (range 24–53 months)\\u000a the International Knee Documentation Committee (IKDC) evaluation form, Lysholm and Tegner rating systems were used to evaluate\\u000a symptoms, functional limitations during sports and daily

P. P. Mariani; E. Adriani; N. Santori; G. Maresca

1997-01-01

50

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using In Situ Hamstring Graft With 4 Tunnels  

PubMed Central

A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction have less-than-optimal results. Although overall outcomes of ACL reconstruction are favorable, there remains considerable room for improvement. Anatomically, the ACL consists of 2 major functional bundles, the anteromedial bundle and the posterolateral bundle. Biomechanically, both bundles contribute significantly to the anterior and rotational stability of the knee. Therefore anatomic double-bundle ACL reconstruction techniques may further improve the outcomes in ACL surgery. This article presents a technique for arthroscopic double-bundle ACL reconstruction that includes the use of 2 femoral and 2 tibial tunnels to restore both the anteromedial and posterolateral bundles of the ACL with minimal hardware for fixation.

Wagih, Ahmad M.

2013-01-01

51

Anterior Cruciate Ligament Injuries in Soccer Players : An Overview  

Microsoft Academic Search

Soccer is known as a sport with high risk of anterior cruciate ligament (ACL) injury. Until 1980s, an ACL injury was a career-ending injury for a soccer player, but afterwards with the technological advancement in the field of medical sciences it could be treated or cured to a greater extent. Prevalence of this injury is two times greater among female

Amit Bandyopadhyay; Shazlin Shaharudin

2009-01-01

52

Graft Fixation Alternatives in Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Reconstruction of the anterior cruciate ligament is a frequently performed procedure with outstanding results. Results are dependent upon an early postoperative physical therapy pro- gram that stresses early motion. Early rehabilitation demands rigid intraoperative mechanical fixation of the graft since therapy begins prior to biologic incorporation of the graft in the bone tunnels. Regardless of the graft substitute chosen, many

RUDY ROBBE; DARREN L. JOHNSON

2002-01-01

53

The biomechanics of anterior cruciate ligament rehabilitation and reconstruction  

Microsoft Academic Search

The rehabilitation of knee injuries involving the anterior cruciate ligament (ACL) is controversial. This paper describes strain in the normal and reconstructed ACL during a series of passive and active tests of knee flexion with and without varus, valgus, and axial rotation torques on the tibia. Strain in the human knee ACL was significantly different depending on whether the knee

Steven W. Arms; Malcolm H. Pope; Robert J. Johnson; Richard A. Fischer; Inga Arvidsson; Ejnar Eriksson

1984-01-01

54

Criterion-based rehabilitation program after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Traditional rehabilitation protocols consist of a progression of exercises and functional activities based on timeframes that serve as strict guidelines for physical therapists and athletic trainers. Patients who have undergone reconstruction of the anterior cruciate ligament are guided through the process via written schedule which often overlooks their ability to master basic functional activities, such as walking. Basic science and

Elizabeth A. Eckersley; Julie M. Fritz; James J. Irrgang

1995-01-01

55

Activity progression for anterior cruciate ligament injured individuals?  

PubMed Central

Background Functional exercises are important in the rehabilitation of anterior cruciate ligament deficient and reconstructed individuals but movement compensations and incomplete recovery persist. This study aimed to identify how tasks pose different challenges; and evaluate if different activities challenge patient groups differently compared to controls. Methods Motion and force data were collected during distance hop, squatting and gait for 20 anterior cruciate ligament deficient, 21 reconstructed and 21 controls. Findings Knee range of motion was greatest during squatting, intermediate during hopping and smallest during gait (P < 0.01). Peak internal knee extensor moments were greatest during distance hop (P < 0.01). The mean value of peak knee moments was reduced in squatting and gait (P < 0.01) compared to hop. Peak internal extensor moments were significantly larger during squatting than gait and peak external adductor moments during gait compared to squatting (P < 0.01). Fluency was highest during squatting (P < 0.01). All patients demonstrated good recovery of gait but anterior cruciate ligament deficient adopted a strategy of increased fluency (P < 0.01). During squatting knee range of motion and peak internal knee extensor moment were reduced in all patients (P < 0.01). Both anterior cruciate ligament groups hopped a shorter distance (P < 0.01) and had reduced knee range of motion (P < 0.025). Anterior cruciate ligament reconstructed had reduced fluency (P < 0.01). Interpretation Distance hop was most challenging; squatting and gait were of similar difficulty but challenged patients in different ways. Despite squatting being an early, less challenging exercise, numerous compensation strategies were identified, indicating that this may be more challenging than gait.

Button, Kate; Roos, Paulien E.; van Deursen, Robert W.M.

2014-01-01

56

Anterior cruciate ligament reconstruction in a 75 years old man: a case report with review of literature.  

PubMed

Anterior cruciate ligament (ACL) reconstruction is usually recommended for young patients. Several recent articles have however reported comparable outcomes of ACL reconstruction between youth and patients in fourth or fifth age group. But in the literature there are not many reports about ACL reconstruction in patients over 70 years old. We report a case of a successful arthroscopic ACL reconstruction (using single bundle quadrupled hamstring graft) in an active 75-year-old medical practitioner. Successful outcome after ACL reconstruction can be achieved in selected older patients; chronological age is no barrier. PMID:24698585

Vaishya, Raju; Dhiman, Radhey Shyam; Vaish, Abhishek

2014-04-01

57

A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients  

Microsoft Academic Search

The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n=28) and four-strand semitendinosus\\/gracilis (ST\\/G group) (n=31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study.

Michael Svensson; Ninni Sernert; Lars Ejerhed; Jon Karlsson; Jüri T. Kartus

2006-01-01

58

Anterior Cruciate Ligament Graft Choices: A Review of Current Concepts  

PubMed Central

The graft choice for anterior cruciate ligament (ACL) reconstruction continues to be controversial. There are several options available for the treating surgeon, including Bone Patellar Tendon Bone (BPTB) grafts, Hamstring tendon (HT) grafts, allografts and synthetic grafts. Within the last decade there have been several comparative trials and meta-analysis, which have failed to provide an answer with regards to the best graft available. The aim of this review is to understand the current concepts in graft choices for ACL reconstruction.

Dheerendra, Sujay K; Khan, Wasim S; Singhal, Rohit; Shivarathre, Deepak G; Pydisetty, Ravi; Johnstone, David

2012-01-01

59

Biomechanics of the porcine triple bundle anterior cruciate ligament  

Microsoft Academic Search

Several species of animals are used as a model to study human anterior cruciate ligament (ACL) reconstruction. In many animals,\\u000a three bundles were clearly discernible during dissection in the ACL. However, there are few reports about the biomechanical\\u000a role of each bundle in the porcine knee. The purpose of this study is to investigate the role of each of the

Yuki Kato; Sheila J. M. Ingham; Monica Linde-Rosen; Patrick Smolinski; Takashi Horaguchi; Freddie H. Fu

2010-01-01

60

“Biological failure” of the anterior cruciate ligament graft  

Microsoft Academic Search

Anterior cruciate ligament (ACL) reconstruction has the best chance for success when the graft undergoes extensive biologic\\u000a remodeling and incorporation after implantation. There are many factors that can lead to graft failure and possible revision\\u000a surgery. These include patient selection; surgical technique such as graft placement and tensioning; the use of allograft\\u000a versus autograft; mechanical factors such as secondary restraint

J. Ménétrey; V. B. Duthon; T. Laumonier; D. Fritschy

2008-01-01

61

Evidence-based rehabilitation following anterior cruciate ligament reconstruction  

Microsoft Academic Search

Following a bone-patellar tendon-bone autograft (BPTB) or four-stranded semitendinosus\\/gracilis tendons autograft (ST\\/G) anterior\\u000a cruciate ligament (ACL) reconstruction, the speed and safety with which an athlete returns to sports (or regains the pre-injury\\u000a level of function) depends on the rehabilitation protocol. Considering the large differences in clinical and outpatient protocols,\\u000a there is no consensus regarding the content of such a rehabilitation

S. van Grinsven; R. E. H. van Cingel; C. J. M. Holla; C. J. M. van Loon

2010-01-01

62

Graft fixation alternatives in anterior cruciate ligament reconstruction  

Microsoft Academic Search

Reconstruction of the anterior cruciate ligament is a frequently performed procedure that has had outstanding results. Outcomes\\u000a are dependent upon an early postoperative physical therapy program that stresses early motion. Early rehabilitation demands\\u000a rigid intraoperative mechanical fixation of the graft since therapy begins before biologic incorporation of the graft in the\\u000a bone tunnels. Regardless of the graft substitute chosen, many

Bernardino Saccomanni

63

Risk factors for a contralateral anterior cruciate ligament injury  

Microsoft Academic Search

Contralateral anterior cruciate ligament (ACL) injuries are together with the risk of developing osteoarthritis of the knee\\u000a and the risk of re-rupture\\/graft failure important aspects to consider after an ACL injury. The aim of this review was to\\u000a perform a critical analysis of the literature on the risk factors associated with a contralateral ACL injury. A better understanding\\u000a of these

Per Swärd; Ioannis Kostogiannis; Harald Roos

2010-01-01

64

Modeling and rehabilitation following anterior cruciate ligament reconstruction  

Microsoft Academic Search

Background\\/Purpose: This study sought to examine the effectiveness of a modeling video to reduce preoperative perceptions of anxiety and pain,\\u000a as well as to increase postoperative self-efficacy and functional outcomes after anterior cruciate ligament reconstruction.Methods: Following baseline assessment of state anxiety, perceptions of expected pain, injury severity, and knee function (International\\u000a Knee Documentation Committee [IKDC] system), patients scheduled for surgical

Ralph Maddison; Harry Prapavessis; Mark Clatworthy

2006-01-01

65

MRI analysis of tibial position of the anterior cruciate ligament  

Microsoft Academic Search

This study aimed to establish normal values for the position of the native anterior cruciate ligament (ACL) insertion on the\\u000a tibia to assist in the evaluation of tunnel placement after primary ACL reconstruction or prior to revision surgery. One hundred\\u000a consecutive MRI studies performed on patients with a mean age of 29 years (range 20–35) from a single MRI facility were

Rachel M. FrankShane; Shane T. Seroyer; Paul B. Lewis; Bernard R. Bach; Nikhil N. Verma

2010-01-01

66

Arthroscopic Versus Open Shoulder Stabilization for Recurrent Anterior InstabilityA Prospective Randomized Clinical Trial  

Microsoft Academic Search

Background: Arthroscopic stabilization for anterior shoulder instability has been reported to result in a higher rate of recurrent instability compared to traditional open techniques. Purpose: To test the null hypothesis that there is no difference in the clinical outcomes in patients with recurrent anterior shoulder instability treated with open or arthroscopic stabilization. Study Design: Randomized controlled trial; Level of evidence,

Craig R. Bottoni; Eric L. Smith; Mark J. Berkowitz; Robert B. Towle; Josef H. Moore

2006-01-01

67

Arthroscopic management of shoulder instabilities: anterior, posterior, and multidirectional.  

PubMed

Arthroscopy is considered a relatively new technique for the surgical repair of an unstable shoulder. Shoulder arthroscopy has grown in popularity and is considered the gold standard for treating carefully selected patients. Despite its increasing popularity, the procedure has a significant learning curve and has resulted in early higher recurrence rates when compared with patients treated with open techniques. With the addition of newer instrumentation, the refinement of techniques, and additional capsular plication and tensioning, outcomes for patients treated with shoulder arthroscopy should continue to improve. A major distinguishing feature in selecting appropriate candidates for shoulder arthroscopy is whether there have been significant bone changes resulting from dislocation recurrence. Recurrent anterior dislocation may create an anterior glenoid rim fracture, erosion loss from multiple recurrences, and an impression defect on the posterior aspect of the humeral head. The loss of contact area between the "ball and cup" may compromise the results of techniques that restore the anatomic restraints of soft tissues. Early intervention is becoming recognized as an important factor in patient selection for arthroscopic treatment. Imaging studies after traumatic injuries include radiographs, CT scans, possible articular contrast studies, and MRIs. These studies can identify and quantify rim fractures and the remaining articular contact in patients with recurrent subluxations, allowing for earlier appropriate intervention. Patients with significant bone loss may be best treated with an open procedure that allows grafting of the deficiency. Arthroscopic techniques to repair fractures or graft deficiencies continue to evolve. Rim fractures can be anatomically repaired with a suture anchor technique when recognized early. Rim erosion from chronic recurrent dislocations may require a combination of soft-tissue reattachment and coracoid grafting. Humeral head defects may require either soft-tissue or bone grafting to avoid engagement with the anterior edge of the glenoid. These techniques require arthroscopic skill and experience and are currently being performed as open procedures. In the future, it is likely that arthroscopy will be involved in the entire spectrum of treatment for shoulder instability. PMID:20415377

Abrams, Jeffrey S; Bradley, James P; Angelo, Richard L; Burks, Robert

2010-01-01

68

To Study the Incidence of Heterotopic Ossification After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Introduction: Previous studies have enumerated the advantages of an arthroscopic Anterior Cruciate Ligament (ACL) reconstruction with the use of a Bone Patellar Tendon Bone (BPTB) graft. Complications are extremely rare in such surgeries and one such known complication, which is an extra-articular heterotophic ossification at the femoral tunnel site, is rarely seen only in few patients. Aim: To evaluate the incidence of heterotrophic ossifications at the femoral tunnel site and the efficacy of the preventive measures which were undertaken, in patients who had undergone ACL reconstructions with the use of bone patellar tendon bone grafts. Material and Methods: A total of 285 patients who had ACL tears within a duration of six years, were evaluated prospectively for the incidence of heterotrophic ossifications after they underwent arthroscopic reconstructions with the use of bone patellar tendon bone grafts by the double incision technique. The effect of the efficacy of various preventive measures on the incidence of the heterotophic ossifications post surgery was also studied. Results: The observed incidence of the heterotophic ossifications was 2.58% in patients whom preventive measures were not used. In contrast, an incidence of 1.54% of similar complications was recorded, after preventive measures were undertaken. Our results showed that heterotophic ossifications after arthroscopic reconstructions with the use of bone patellar tendon bone grafts were a rare complication and that their incidence could be further reduced if preventive measures were taken. Conclusion: The heterotophic ossification is a rare complication after an ACL reconstruction is done with the use of a bone patellar tendon bone graft by the double incision technique. Its incidence reduces significantly after preventive measures are undertaken.

Bhandary, Bhaskara; Shetty, Sudeep; Bangera, Vinay V.; R., Yogaprakash; Kassim, Mohammed Shabir; Alva, Karan; Bhandary, Sudarshan

2013-01-01

69

Deep Lateral Femoral Notch: A Sign of Anterior Cruciate Ligament Disruption.  

National Technical Information Service (NTIS)

The 'deep lateral femoral notch' sign refers to an osteochondral impaction injury of the lateral femoral condyle that is associated with disruption of the anterior cruciate ligament (ACL). At the time of injury, the tibia translates anteriorly relative to...

L. Folio T. G. Sanders

2007-01-01

70

Intercondylar notch size and anterior cruciate ligament injuries in athletesA prospective study  

Microsoft Academic Search

Published reports agree that there is a strong associa tion between intercondylar notch stenosis and anterior cruciate ligament injuries. In a previously published retrospective study on bilateral anterior cruciate liga ment injuries and associated intercondylar notch ste nosis, we formulated the notch width index to measure and compare intercondylar notch width. The purpose of this prospective study was to establish

Tarek O. Souryal; Tandy R. Freeman

1993-01-01

71

The Long-term Consequence of Anterior Cruciate Ligament and Meniscus InjuriesOsteoarthritis  

Microsoft Academic Search

The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50%

L. Stefan Lohmander; P. Martin Englund; Ludvig L. Dahl; Ewa M. Roos

2007-01-01

72

The association between lower extremity energy absorption and biomechanical factors related to anterior cruciate ligament injury  

Microsoft Academic Search

BackgroundGreater total energy absorption by the lower extremity musculature during landing may reduce stresses placed on capsuloligamentous tissues with differences in joint contributions to energy absorption potentially affecting anterior cruciate ligament injury risk. However, the relationships between energy absorption and prospectively identified biomechanical factors associated with non-contact anterior cruciate ligament injury have yet to be demonstrated.

Marc F. Norcross; J. Troy Blackburn; Benjamin M. Goerger; Darin A. Padua

2010-01-01

73

Association Between the Menstrual Cycle and Anterior Cruciate Ligament Injuries in Female Athletes  

Microsoft Academic Search

Anterior cruciate ligament injury rates are four to eight times higher in women than in men. Because of estrogen's direct effect on collagen metabolism and behavior and because neuromuscular performance varies during the menstrual cycle, it is logical to question the menstrual cycle's effect on knee injury rates. Of 40 consecutive female athletes with acute anterior cruciate ligament injuries (less

Edward M. Wojtys; Laura J. Huston; Thomas N. Lindenfeld; Timothy E. Hewett; Mary Lou V. H. Greenfield

1998-01-01

74

The anterior cruciate ligament-deficient knee and unicompartmental arthritis.  

PubMed

Treatment of medial and lateral compartment arthritis in the anterior cruciate ligament (ACL)-deficient knee remains a topic of debate among orthopedic surgeons. This article discusses the treatment options for the ACL-deficient knee with unicompartmental arthritis and provides a rationale for clinical decision making in this difficult group of patients. Unicondylar knee arthroplasty (UKA) is a viable option in a select group of patients to decrease pain and maintain an active lifestyle. When performing a UKA in an ACL-deficient knee, it is important to manage appropriate expectations for a successful outcome. PMID:24274844

Plancher, Kevin D; Dunn, Albert S M; Petterson, Stephanie C

2014-01-01

75

Ossicle in Anterior Cruciate Ligament: A Rare Occurrence  

PubMed Central

The occurrence of an intra-articular ossicle is not rare in the knee, with reports suggesting the existence of meniscal osscile. There are also reports describing the attachment of the posterolateral bundle of the anterior cruciate ligament (ACL) to an accessory ossicle. However, despite an extensive search of the English literature we did not find much written about an intrasubstance ossicle in the ACL. We present the case of a 13-year-old male with an intrasubstance ossicle in the anteromedial bundle of the ACL of his right knee.

Singh, Amanpreet; Gogna, Paritosh

2014-01-01

76

Mucoid degeneration of the anterior cruciate Ligament: a case report  

PubMed Central

We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and symptoms, including those found in our case. Magnetic Resonance Imaging is the most useful tool for differentiating mucoid degeneration of the ACL from an intraligamentous ganglion or other lesions in the knee joint. If this disease is considered preoperatively, it can be diagnosed easily based on characteristic findings.

el Kadi, Khalid Ibn; Marcaillou, Florian; Blanc, Stephane; Salloum, Bassam; Dimontagliari, Cyril; Boutayeb, Fawzi

2013-01-01

77

Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency  

PubMed Central

The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality.

Maiotti, Marco; Massoni, Carlo

2013-01-01

78

Instrumented measurement of in vivo anterior–posterior translation in the canine knee to assess anterior cruciate integrity  

Microsoft Academic Search

This study was designed to objectively quantify in vivo anterior–posterior canine knee translation relative to anterior cruciate ligament (ACL) integrity. Tibial translation was determined in one knee of 43 crossbreed hounds from radiographs performed while a set anterior and then posterior force was applied to the tibia using a custom designed device. The total (TTT), anterior (ATT), and posterior (PTT)

Mandi J. Lopez; William Hagquist; Susan L. Jeffrey; Sara Gilbertson; Mark D. Markel

2004-01-01

79

A New Anterior Cruciate Ligament Reconstruction Fixation Technique (Quadrupled Semitendinosus Anterior Cruciate Ligament Reconstruction With Polyetheretherketone Cage Fixation)  

PubMed Central

Fixation of the graft during anterior cruciate ligament reconstruction surgery has been the subject of numerous technical innovations but still remains a challenge. This article describes a novel technique of graft fixation for hamstring tendon reconstruction: the Cage For One system (Sacimex, Aix-en-Provence, France). The technique uses only the semitendinosus tendon, which is looped to create a 4-strand graft. Leaving the gracilis tendon intact probably reduces the loss of knee flexion strength. The graft is indirectly anchored into both tunnels with polyetheretherketone cages by use of polyethylene terephthalate tape strips. Both cages and strips are magnetic resonance imaging compatible and do not create artifacts. The tunnels are drilled by an outside-in method with minimal incisions. This type of fixation creates a 360° bone contact at 1.5 cm in each tunnel and is compatible with double-bundle reconstruction. This easy-to-use novel technique of fixation for anterior cruciate ligament reconstruction produces a strong 4-strand graft while harvesting only the semitendinosus tendon and leaving the gracilis tendon intact to reduce flexion strength loss and preserve rotatory stability of the knee. It creates an immediate solid fixation that is independent of graft integration in the early postoperative period, allowing the patient to start immediate rehabilitation without the use of a brace.

Calas, Philippe; Dorval, Nicolas; Bloch, Anthony; Argenson, Jean-Noel; Parratte, Sebastien

2012-01-01

80

Risks, benefits, and evidence-based recommendations for improving anterior cruciate ligament outcomes.  

PubMed

Recently, injuries to the anterior cruciate ligament and subsequent surgical reconstructions have seen a great increase in interest from the perspectives of basic science, anatomy, mechanics, and clinical outcomes. Over the past few years, an emerging body of evidence has shown the importance of a more anatomic anterior cruciate ligament reconstruction, which uses sound anatomic and surgical principles, identifies an ideal graft for the patient, and ensures that all aspects of care (including postoperative rehabilitation) are fully addressed. It is helpful for orthopaedic surgeons to review the surgically relevant anatomy of the anterior cruciate ligament, graft choices, fixation techniques and constructs, and rehabilitation guidelines to optimize outcomes for their patients. PMID:24720322

Lubowitz, James H; Verma, Nikhil N; Tokish, John M; Goradia, Vipool K; McNeil, John W; Provencher, Cdr Matthew T

2014-01-01

81

Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities  

Microsoft Academic Search

The functional anatomy of the anterior cruciate ligament was studied in 18 freshly amputated specimens. The cruciates were observed in the extremes of flexion and extension, and in midposition in simulated weight-bearing and nonweight-bearing conditions. Five femoral shafts were split longitudinally so that the femoral and tibial attachments of the ligament could be inspected. The findings indicated that (1) the

Lyle A. Norwood; Mervyn J. Cross

1979-01-01

82

A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.  

ERIC Educational Resources Information Center

The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

Weesner, Carol L.; And Others

1986-01-01

83

Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation  

PubMed Central

Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum) showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 (P < 0.001) postoperatively. The Lysholm score too showed statistically significant (P < 0.001) improvement from 52.4 ± 15.2 (range: 32-76) preoperatively to a postoperative score of 89.1 ± 3.2 (range 67-100). According to the IKDC score 90% patients had normal results (Category A and B). The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6 patients intraoperatively. The quadriceps strength on isokinetic testing had an average deficit of 10.3% while the hamstrings had a 5.2% deficit at the end of 1 year as compared with the normal side. Conclusion: Our study revealed that the DBACL reconstruction using crosspin fixation for AM bundle and aperture fixation for PL bundle on the femoral side resulted in significant improvement in KT 1000, Lysholm and IKDC scores.

Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

2014-01-01

84

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic “all-inside” double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of double–tibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction.

Yasen, Sam K.; Logan, James S.; Smith, James O.; Nancoo, Tamara; Risebury, Mike J.; Wilson, Adrian J.

2013-01-01

85

Extensor strength in the anterior cruciate reconstructed knee.  

PubMed

Truncated range average torque (TRAT), peak torque (PT) and angle of peak torque (APT) in the knee extensor musculature of subjects with patellar tendon autograft anterior cruciate ligament reconstructions were compared with non-operated limbs two to four years following surgery. Twenty subjects were assessed using a Kin-Com 500H isokinetic dynamometer at three velocities for both concentric and eccentric muscle actions. Results of TRAT for the knee extensors showed average concentric and eccentric deficits of 8.48 per cent and 6.73 per cent, respectively. Deficits in PT were 8.26 per cent concentrically and 7.96 per cent eccentrically. There was no difference in the APT for each action or velocity. Despite an accelerated rehabilitation program, significant residual deficits were evident. Continued strengthening of the knee extensor muscles is recommended. PMID:25025968

Chapman, A; Chamberlain, V; Railton, R; Boyle, J; Strauss, G

1995-01-01

86

Operative treatment of primary anterior cruciate ligament rupture in adults.  

PubMed

Operative management of an acute anterior cruciate ligament (ACL) rupture may be required in young and active patients to stabilize the knee and return patients to desired daily activities. ACL reconstruction should be performed anatomically. The majority of studies show no differences between anatomic single-bundle and double-bundle ACL reconstruction with respect to patient-reported outcome scores. Double-bundle reconstruction may provide superior knee joint laxity measurements compared with the single-bundle technique. Following ACL reconstruction, the age and activity level of a patient are predictive of his or her time of return to sports and reinjury. Concomitant meniscal and/or cartilage damage at the time of surgery, in addition to a persistent knee motion deficit, are associated with the development of osteoarthritis after ACL reconstruction. PMID:24740666

Murawski, Christopher D; van Eck, Carola F; Irrgang, James J; Tashman, Scott; Fu, Freddie H

2014-04-16

87

Biomimetic tissue-engineered anterior cruciate ligament replacement  

PubMed Central

There are >200,000 anterior cruciate ligament (ACL) ruptures each year in the United States, and, due to the poor healing properties of the ACL, surgical reconstruction with autograft or allograft tissue is the current treatment of these injuries. To regenerate the ACL, the ideal matrix should be biodegradable, porous, and exhibit sufficient mechanical strength to allow formation of neoligament tissue. Researchers have developed ACL scaffolds with collagen fibers, silk, biodegradable polymers, and composites with limited success. Our group has developed a biomimetic ligament replacement by using 3D braiding technology. In this preliminary in vivo rabbit model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regeneration with our cell-seeded, tissue-engineered ligament replacement.

Cooper, James A.; Sahota, Janmeet S.; Gorum, W. Jay; Carter, Janell; Doty, Stephen B.; Laurencin, Cato T.

2007-01-01

88

Allografts in the treatment of anterior cruciate ligament injuries.  

PubMed

Symptomatic knee instability is a common complaint among athletic individuals after a torn anterior cruciate ligament (ACL) of the knee. Allograft ACL reconstruction has gained popularity for primary and revision reconstructions. This graft choice has become popular with good intermediate term results combined with decreased operative times, hospital costs, and improved immediate postoperative pain and function. Intermediate follow-up has demonstrated similar results with autograft reconstructions, without the addition of donor site morbidity. Multiple allograft options exist for ACL reconstruction. The most commonly selected grafts include patellar tendon, Achilles tendon, and tibialis allografts. The use of a tibialis allograft provides a stout graft for reconstruction, while minimizing bone tunnel size. Bone-patella-bone allografts provide bone to bone fixation options with flexibility in tunnel selection sizing. PMID:17700373

Kuhn, Michael A; Ross, Glen

2007-09-01

89

Influence of acute anterior cruciate ligament deficiency in gait variability.  

PubMed

The objective of this study was to compare the gait variability of patients with isolated anterior cruciate ligament (ACL) deficiency (experimental group) with that of healthy individuals (control group). The hypothesis was that the gait variability of the experimental group would be higher than the control group. The experimental group consisted of 20 men with an ACL tear and the control group consisted of 20 healthy men without any neurological and/or musculoskeletal pathology or injury. The gait acceleration signal was analysed using the Gait Evaluation Differential Entropy Method (GEDEM). The GEDEM index of the experimental group in the medio-lateral axis was significantly higher than that of the control subjects. A receiver operating characteristic (ROC) analysis was used to assess the diagnostic value of the method and to determine a cut-off entropy value. The GEDEM cut-off value had a 95.6% probability of separating isolated ACL patients from healthy subjects. PMID:20515565

Tzagarakis, G N; Tsivgoulis, S D; Papagelopoulos, P J; Mastrokalos, D S; Papadakis, N C; Kampanis, N A; Kontakis, G M; Nikolaou, P K; Katonis, P G

2010-01-01

90

Biomimetic tissue-engineered anterior cruciate ligament replacement.  

PubMed

There are >200,000 anterior cruciate ligament (ACL) ruptures each year in the United States, and, due to the poor healing properties of the ACL, surgical reconstruction with autograft or allograft tissue is the current treatment of these injuries. To regenerate the ACL, the ideal matrix should be biodegradable, porous, and exhibit sufficient mechanical strength to allow formation of neoligament tissue. Researchers have developed ACL scaffolds with collagen fibers, silk, biodegradable polymers, and composites with limited success. Our group has developed a biomimetic ligament replacement by using 3D braiding technology. In this preliminary in vivo rabbit model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regeneration with our cell-seeded, tissue-engineered ligament replacement. PMID:17360607

Cooper, James A; Sahota, Janmeet S; Gorum, W Jay; Carter, Janell; Doty, Stephen B; Laurencin, Cato T

2007-02-27

91

Clinical results of computer-navigated anterior cruciate ligament reconstructions.  

PubMed

Growing participation in sports activities over recent years has increased the number of anterior cruciate ligaments (ACL) injuries. Thus, more surgeons became active in this field, leading to a high incidence of transplant failure. In the past 2 1/2 years, 235 patients were treated through navigated ACL reconstruction with semitendinosus-gracilis tendon (STG) autograft. One hundred patients who returned for the follow-up examinations were evaluated. In all cases without concurring injuries, the clinical outcome was excellent or very good. Postoperative radiological examination showed correct positioning of the EndoButton (Smith and Nephew, Mansfield, Mass.) and the Suture Plate (B. Braun-Aesculap, Tuttlingen, Germany) in all patients. The subjective and objective stability assessment did not show any significant difference to the uninjured opposite side. PMID:16235457

Valentin, Peter; Hofbauer, Marcus; Aldrian, Silke

2005-10-01

92

Osteomyelitis of the tibia following anterior cruciate ligament reconstruction  

PubMed Central

INTRODUCTION Osteomyelitis following anterior cruciate ligament (ACL) reconstruction is extremely rare. PRESENTATION OF CASE We present a thirty year old man who presented with pain in his proximal tibia six years after ACL reconstruction. Haematological investigations were normal. He was diagnosed with osteomyelitis of his proximal tibia. He was successfully treated with washout and debridement of his tibial tunnel. DISCUSSION This case highlights the need to exclude osteomyelitis as a late complication of ACL reconstruction in patients with proximal tibial pain. We also report on an unusual pathogen as casue of osteomyelitis. CONCLUSION Osteomyelitis in a tibial tunnel can present as a late complication of ACL reconstruction, even in the presence of normal haematological investigations.

O'Neill, Barry J.; Molloy, Alan P.; McCarthy, Tom

2012-01-01

93

Characteristics of anterior cruciate ligament injuries in Australian football.  

PubMed

Anterior cruciate ligament (ACL) injuries are the most costly injuries in football at both professional and amateur levels (Orchard J, Seward H, McGivern J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 2001;29:196-200.). In this study video analysis of 34 ACL injuries in Australian football was performed to investigate the causes of these injuries. Factors that may have contributed to the cause of the injury were analysed, rated and reported. The factors analysed were: type of manoeuvre, direction the knee 'gave way', running speed, knee angle, cutting angle and if the player was accelerating or decelerating. The majority of the injuries analysed occurred in non-contact situations (56%). Of these 37% occurred during sidestepping manoeuvres, 32% in landing, 16% land and step, 10% stopping/slowing and 5% crossover cut manoeuvres. Ninety-two percent of the non-contact injuries occurred at extended knee angles of 30 degrees or less, which is also commonly known to place stress on the ACL and reduce the protective role of hamstrings. Over half (54%) of non-contact injuries occurred whilst decelerating. It would be expected that greater speed and angle cut too would increase the frequency of ACL injury. The results could not confirm this with most injuries occurring at running speeds of slow jogging to running and equal number of injuries occurred at cutting to angles of the ranges 15-45 degrees and 45-75 degrees. These results give greater understanding into potential causes or contributors of ACL injury and information to assist in the development of knee injury prevention programs. PMID:16807104

Cochrane, Jodie L; Lloyd, David G; Buttfield, Alec; Seward, Hugh; McGivern, Jeanne

2007-04-01

94

Diagnostic Value of Knee Arthrometry in the Prediction of Anterior Cruciate Ligament Strain During Landing  

PubMed Central

Background Previous studies have indicated that higher knee joint laxity may be indicative of an increased risk of anterior cruciate ligament (ACL) injuries. Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/Hypotheses The purpose of this study was to evaluate the relationships between ACL strain and anterior knee laxity measurements using arthrometry during both a drawer test and simulated bipedal landing (as an identified high-risk injurious task). We hypothesized that a high correlation exists between dynamic ACL strain and passive arthrometry displacement. The secondary hypothesis was that anterior knee laxity quantified by knee arthrometry is a valid predictor of injury risk such that specimens with greater anterior knee laxity would demonstrate increased levels of peak ACL strain during landing. Study Design Controlled laboratory study. Methods Twenty cadaveric lower limbs (mean age, 46 ± 6 years; 10 female and 10 male) were tested using a CompuKT knee arthrometer to measure knee joint laxity. Each specimen was tested under 4 continuous cycles of anterior-posterior shear force (±134 N) applied to the tibial tubercle. To quantify ACL strain, a differential variable reluctance transducer (DVRT) was arthroscopically placed on the ACL (anteromedial bundle), and specimens were retested. Subsequently, bipedal landing from 30 cm was simulated in a subset of 14 specimens (mean age, 45 ± 6 years; 6 female and 8 male) using a novel custom-designed drop stand. Changes in joint laxity and ACL strain under applied anterior shear force were statistically analyzed using paired sample t tests and analysis of variance. Multiple linear regression analyses were conducted to determine the relationship between anterior shear force, anterior tibial translation, and ACL strain. Results During simulated drawer tests, 134 N of applied anterior shear load produced a mean peak anterior tibial translation of 3.1 ± 1.1 mm and a mean peak ACL strain of 4.9% ± 4.3%. Anterior shear load was a significant determinant of anterior tibial translation (P <.0005) and peak ACL strain (P = .04). A significant correlation (r = 0.52, P <.0005) was observed between anterior tibial translation and ACL strain. Cadaveric simulations of landing produced a mean axial impact load of 4070 ± 732 N. Simulated landing significantly increased the mean peak anterior tibial translation to 10.4 ± 3.5 mm and the mean peak ACL strain to 6.8% ± 2.8% (P <.0005) compared with the prelanding condition. Significant correlations were observed between peak ACL strain during simulated landing and anterior tibial translation quantified by knee arthrometry. Conclusion Our first hypothesis is supported by a significant correlation between arthrometry displacement collected during laxity tests and concurrent ACL strain calculated from DVRT measurements. Experimental findings also support our second hypothesis that instrumented measures of anterior knee laxity predict peak ACL strain during landing, while specimens with greater knee laxity demonstrated higher levels of peak ACL strain during landing. Clinical Relevance The current findings highlight the importance of instrumented anterior knee laxity assessments as a potential indicator of the risk of ACL injuries in addition to its clinical utility in the evaluation of ACL integrity.

Kiapour, Ata M.; Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Levine, Jason W.; Goel, Vijay K.; Demetropoulos, Constantine K.; Hewett, Timothy E.

2014-01-01

95

Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management  

PubMed Central

After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management.

Aydin, Nuri; Sirin, Evrim; Arya, Alp

2014-01-01

96

Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management.  

PubMed

After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management. PMID:25035838

Aydin, Nuri; Sirin, Evrim; Arya, Alp

2014-07-18

97

Experiences of professional rugby union players returning to competition following anterior cruciate ligament reconstruction  

Microsoft Academic Search

ObjectivesThe purpose of this study was to gain a greater understanding of the emotions and coping strategies utilized when returning to competition following anterior cruciate ligament (ACL) reconstruction.

Fraser Carson; Remco Polman

98

[Temporary postoperative protection of the anterior cruciate ligament with transarticular wire rope].  

PubMed

This article describes an operational method for the temporary protection of the anterior cruciate ligament after acute or late ligament reconstruction. In line with the course of the anterior cruciate ligament a wire rope is transarticularly implanted and fixed with a screw each at the femur (proximally) and at the tibia bone (distally). This easily performed method permits both the healing of the ligament lesion while preserving the original ligament length and the execution of an early functional exercise therapy. PMID:1971482

Weigand, H; Storm, H; Birne, F U

1990-04-01

99

Augmentation of autologous hamstring graft during anterior cruciate ligament reconstruction using the bone chip technique  

Microsoft Academic Search

The use of autologous quadrupled hamstring tendon graft is a well-known technique for anterior cruciate ligament reconstruction.\\u000a In cases where the diameter of the graft is inadequate, the stability of graft fixation and subsequent bone to tendon healing\\u000a may be compromised. We describe a new technique to augment the autologous double looped hamstring tendon graft during anterior\\u000a cruciate ligament reconstruction

Kyung Wook Nha; Gautam M. Shetty; Jin Hwan Ahn; Yong Seuk Lee; Dong Ju Chae; Hyok Woo Nam; Dae Hee Lee

2010-01-01

100

Arthroscopic studies of variants of the anterior horn of the medial meniscus  

Microsoft Academic Search

The objective of this study was to arthroscopically analyse the morphology and dynamics of variants of the anterior horn of the medial meniscus of the knee (VAMM) and to then consider the pathological significance of these variants. VAMM was defined as knees in which the anterior horn of the medial meniscus is not attached to the tibia. Between April 1992

Yasumitsu Ohkoshi; Tatsuto Takeuchi; Chiharu Inoue; Tomoyuki Hashimoto; Keiichi Shigenobu; Shigeru Yamane

1997-01-01

101

Arthroscopic repair of "peel-off" lesion of the posterior cruciate ligament at the femoral condyle.  

PubMed

Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint. PMID:24749037

Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato

2014-02-01

102

Arthroscopic Repair of "Peel-Off" Lesion of the Posterior Cruciate Ligament at the Femoral Condyle  

PubMed Central

Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral “peel-off” injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint.

Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato

2014-01-01

103

Contralateral anterior cruciate ligament injury after anterior cruciate ligament reconstruction: a case controlled study  

PubMed Central

Purpose The purpose of this present study was to examine contralateral ACL injury cases after ACL reconstruction, to determine the characteristics of such injuries. Methods We performed a retrospective analysis of 24 patients with contralateral ACL injury after ACL reconstruction. The control group consisted of 200 cases with unilateral ACL injury. The following were examined in the contralateral group: timing of the contralateral ACL injury, and the situations of the initial and contralateral ACL injuries. The following items were compared between the contralateral and control groups: age at the time of initial injury, level of competitive sports using Tegner activity scores, knee anterior laxity (KT-1000), and the ratio (%) of affected to unaffected legs in the strengths of the knee extensor and flexor muscles 6 months after surgery. Results Examination of injury situations showed that approximately 70% of the contralateral group was injured in situations similar to those at their initial injuries. There were no significant differences between the two groups in age at the time of initial injury , Tegner activity scores, knee anterior laxity, and the strengths of the knee extensor, flexor muscles and H/Q ratio 6 months after reconstruction. But, the age at the time of initial injury trended to be low in contralateral group. Conclusions Knee anterior laxity and muscle weakness of the reconstructed legs six months following surgery were not individually related to contralateral ACL injury occurring approximately two years after surgery.

2012-01-01

104

A modified repair for the anterior cruciate ligament deficient knee.  

PubMed Central

A retrospective analysis of 48 sportsmen and women from an original series of 76 consecutive patients who had undergone a modified McIntosh repair was carried out to establish whether or not the procedure could provide a satisfactory recovery and return to previous ability. The type and level of sport before injury was compared with that after operation. Symptoms of pain and giving way, and examination findings of pivot shift, and Lachman's test were compared before and after operation. Of the 48 patients assessed, 28 (58%) returned to full sporting capacity; 17 (35%) patients were participating in different sports or lower levels of their previous sports, and three patients did not participate in any sport. The more severely symptomatic knees did not perform so well after operation. The degree of preoperative anterior draw and Lachman's test did not influence the final result and the pivot shift, present in all before operation, was abolished in all but one case, which remained badly symptomatic. Concurrent meniscal injury or medial or lateral laxity did not influence return to sport once a full postoperative recovery was made. No deterioration was noticed in the level of sporting ability achieved thereafter. In this study it has been shown that the modified McIntosh repair is a swift extra-articular reconstruction for the anterior cruciate ligament deficient knee, which is less elaborate than previously described Ellison and McIntosh procedures, and which has produced a comparable result.

Holland, J P

1992-01-01

105

Correlation between trochlear dysplasia and anterior cruciate ligament injury.  

PubMed

PURPOSE. To evaluate the correlation between trochlear dysplasia and anterior cruciate ligament (ACL) injury METHODS. Magnetic resonance images (MRIs) of 95 knees in 54 males and 36 females aged 4 to 74 (mean, 28) years who had anterior knee pain and suspected ligamentous injury were reviewed. The MRIs were independently reviewed by 2 musculoskeletal radiologists on 2 occasions. According to the Dejour classification, trochlear dysplasia was classified into types A, B, C, and D. Intra-articular injuries/ disorders of the patients included patellofemoral osteoarthritis, chondromalacia patella, meniscal tears, and ligamentous injuries. Intra- and inter-observer variability was calculated. RESULTS. 58 of the knees had trochlear dysplasia, 38 of which were Dejour type A. The intra- and inter-observer variability was good to excellent (Kappa=0.76-1). ACL tear was the most common injury (n=13). No ACL injury occurred in patients without trochlear dysplasia. The odds of having sustained an ACL injury were 8.8 fold greater in Dejour type-A knees than in non-type-A knees (p=0.023). CONCLUSION. Dejour type-A trochlear dysplasia was associated with ACL injuries. PMID:24014781

Botchu, Rajesh; Obaid, Haron; Rennie, W J

2013-08-01

106

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture.  

PubMed

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery. PMID:9788381

Roberts, C; John, C; Seligson, D

1998-10-01

107

Basic science of anterior cruciate ligament injury and repair.  

PubMed

Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20-31. PMID:24497504

Kiapour, A M; Murray, M M

2014-01-01

108

Ideal tibial tunnel length for endoscopic anterior cruciate ligament reconstruction.  

PubMed

A successful single-incision endoscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft requires attention to many technical details. The emphasis of placing the femoral bone plug flush with the opening of the femoral tunnel results in distal shift of the graft. Longer tibial tunnels are required to prevent excessive graft extrusion. The purpose of this study is to compare four direct and indirect measurement methods of tibial tunnel preparation to determine which method can be used to create consistently reproducible tibial tunnels that prevent excessive extrusion or recession of the graft within the tunnel. Tunnels placed at the empiric angles of 40 degrees, 50 degrees, and 60 degrees to the tibial plateau resulted in the incidence of acceptable tibial tunnel lengths of 44%, 83%, and 39%, respectively. Tunnels placed at an angle determined by the formula "N + 7" where 7 degrees is added to the patellar tendon length (N) resulted in acceptable tunnels 89% of the time. Direct measurement methods using the formulas "graft - 50 mm" and "N + 2 mm" resulted in acceptable tibial tunnels of 44% and 100%, respectively. We recommend using the "N + 7" in conjunction with the "N + 2 mm" formula to obtain the advantages of both indirect and direct measurement methods. PMID:9486327

Olszewski, A D; Miller, M D; Ritchie, J R

1998-01-01

109

Radiation risk from fluoroscopically-assisted anterior cruciate ligament reconstruction  

PubMed Central

INTRODUCTION Precise tunnel positioning is crucial for success in anterior cruciate ligament (ACL) reconstruction. The use of intra-operative fluoroscopy has been shown to improve the accuracy of tunnel placement. Although radiation exposure is a concern, we lack information on the radiation risk to patients undergoing fluoroscopically-assisted ACL reconstruction with a standard C-arm. The aim of our study was to determine the mean radiation doses received by our patients. PATIENTS AND METHODS Radiation doses were recorded for 18 months between 1 April 2007 and 30 September 2008 for 58 consecutive patients undergoing ACL reconstruction assisted by intra-operative fluoroscopy. Dose area product (DAP) values were used to calculate the entrance skin dose (ESD), an indicator of potential skin damage and the effective dose (ED), an indicator of long-term cancer risk, for each patient. RESULTS The median age of 58 patients included in data analysis was 28 years (range, 14–52 years), of whom 44 were male (76%). The mean ESD during intra-operative fluoroscopy was 0.0015 ± 0.0029 Gy. The mean ED was 0.001 ± 0.002 mSv. No results exceeded the threshold of 2 Gy for skin damage, and the life-time risk of developing new cancer due to intra-operative fluoroscopy is less than 0.0001%. CONCLUSIONS Radiation doses administered during fluoroscopically-assisted ACL reconstruction were safe and do not represent a contra-indication to the procedure.

Chitnavis, JP; Karthikesaligam, A; Macdonald, A; Brown, C

2010-01-01

110

Basic science of anterior cruciate ligament injury and repair  

PubMed Central

Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20–31.

Kiapour, A. M.; Murray, M. M.

2014-01-01

111

Factors Affecting Patients' Graft Choice in Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background Multiple studies have reported that allografts are acceptable alternatives to autografts for anterior cruciate ligament (ACL) reconstructions. Our clinical practice allows patient involvement in graft decision-making. This study examined the patients' preference for graft selection and the factors affecting their decision. Methods Patients scheduled to undergo an ACL reconstruction surgery (n = 129) at a university medical center in Korea were enrolled in this study. Information leaflets with graft descriptions were provided prior to hospital admission, and the patients were allowed to choose one of two surgical graft types. The patients were asked to complete a questionnaire that reflected their decision-making processes, and the patients' trends and factors affecting their choice of graft were analyzed based on their responses. Results Most patients (54.3%) selected autografts for the ACL reconstruction. The surgeon's explanation was the most important factor affecting the final patient decision followed by the information derived from Internet searches. Patients who derived the majority of their understanding of the graft types from the Internet chose allografts at significantly higher rates. Conclusions Patient graft selection is a reasonable way of designating the type of surgical procedure. Most patients selected autografts for their ACL reconstruction. However, patients who performed significant Internet-based research tended to prefer allografts.

Koh, Hae Seok; Kong, Chae-Gwan; Won, Ho-Yeon; Kim, Kun-Hyung; Lee, Jung-Han

2010-01-01

112

The human anterior cruciate ligament: histological and ultrastructural observations.  

PubMed Central

In transverse and longitudinal paraffin-embedded sections, the human anterior cruciate ligament (ACL) is made up of wavy bundles of collagen fibres arrayed in various directions, the majority around the axis of the ligament with a few running parallel to it. The fascicles making up the larger bundles are also characterised by this undulating appearance. In thin sections 2 types of collagen fibrils are observed: small (with a single diameter peak at 45 nm) and large (3 peaks at 35, 50 and 75 nm respectively), organised into distinct areas made up of either large or small bundles of fibrils. The numerous fibroblasts that are present appear elongated in the direction of the bundles with branches and short cytoplasmic processes. The elastic system is made up of both elastic and oxytalan fibres. The varied orientation of the bundles in the ACL, the complex ultrastructural organisation and the abundant elastic system make it very different from other ligaments and tendons, providing a structure able to withstand the multiaxial stresses and varying tensile strains imposed upon it. Images Fig. 1 Fig. 2 Fig. 3 Fig. 5 Fig. 6

Strocchi, R; de Pasquale, V; Gubellini, P; Facchini, A; Marcacci, M; Buda, R; Zaffagnini, S; Ruggeri, A

1992-01-01

113

Kinematics of the Anterior Cruciate Ligament During Gait  

PubMed Central

Background The function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) during gait has not been reported. Hypothesis The AM and PL bundles have distinct functional behavior during the stance phase of treadmill gait. Study Design Descriptive laboratory study. Methods Three-dimensional models of the knee were created by magnetic resonance images from 8 healthy subjects. The contour of the 2 bundle attachments were constructed on each model. Each bundle was represented by a straight line connecting its tibial and femoral attachment centroids. Next, the knee kinematics during the stance phase of gait was determined with a dual fluoroscopic imaging system. The relative elongation, sagittal plane elevation, coronal plane elevation, and transverse plane deviation of the 2 bundles were measured directly from heel strike to toe-off. Results At heel strike, the AM and PL bundles had first peak elongation of 9% ± 7% and 9% ± 13%, respectively. At 50% progress of the stance phase, both bundles were maximally elongated, 12% ± 7% for the AM bundle and 13% ± 15% for the PL bundle. No significant difference was found for each bundle between 40% and 60% of the stance phase (P > .05). With increasing knee flexion, the sagittal plane and coronal plane elevations of the 2 bundles decreased, whereas the deviation angles increased. Conclusion Both bundles are anisometric and function in a similar manner during the stance phase of gait. They were maximally elongated throughout the midstance where they were stretched maximally to resist anterior tibial translation. Clinical relevance This information can be useful for further improving anatomical ACL reconstructions to better reproduce the 2 bundle functions. It may also be useful for designing postoperative rehabilitation regimens to prevent overstretch of the grafts.

Wu, Jia-Lin; Hosseini, Ali; Kozanek, Michal; Gadikota, Hemanth R.; Gill, Thomas J.; Li, Guoan

2013-01-01

114

Diagnostic assessment in anterior cruciate ligament (ACL) tears.  

PubMed

(Full text is available at http://www.manu.edu.mk/prilozi). The aim of this study was to compare findings from clinical examinations, MRI scans and arthroscopy in ACL injury of the knee in order to assess the diagnostic significance of both examination findings. This study was conducted to manage the reliability of clinical diagnosis in ACL tear injuries. All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. Of 103 patients with knee problems arthroscopy ACL tears was diagnosed in 73. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was evaluated and confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. The MRI accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Accuracy for two of three clinical examination tests of clinical diagnosis in our study was 96% and 94% for ACL tears. According to our obtained correlation between clinical examinations, MRI scan and arthroscopy for ACL injuries, we concluded that carefully performed clinical examination can give equal or better diagnosis of ACL injuries in comparison with MRI scan. Our study revealed MRI scan high sensitivity and specificity and not so high accuracy for ACL injuries of the knee joint in comparison with arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. According to our findings we can conclude that a positive anterior drawer test and a positive Lachman clinical examination test is more accurate for predicting, i.e. diagnosis of ACL tear. On the ither hand, MRI scan findings showed less accuracy for predicting, i.e. diagnosis of ACL tear. According to many studies of clinical examination tests compared (correlated) with arthroscopy, the accuracy of predicting ACL tears depends on the level of the skilled orthopaedic or trauma surgeon's hands. Based on these findings, we feel that MRI, except in certain circumstances, is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology. Key words: clinical examination test, MRI, arthroscopy, ACL, knee. PMID:24798607

Kostov, H; Arsovski, O; Kostova, E; Nikolov, V

2014-01-01

115

Review on tension in the natural and reconstructed anterior cruciate ligament  

Microsoft Academic Search

This article reviews the methodology and results of published studies concerned with tension in the natural and reconstructed anterior cruciate ligament (ACL). This also includes studies of fiber length changes with knee motion and the relationships between graft tunnel placements and isometricity. Little work has been done in vivo: in humans, length changes of the anterior ACL fibers have been

H. N. Andersen; A. A. Amis

1994-01-01

116

Effect of Femoral Socket Position on Graft Impingement After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Despite improved biomechanical stability and kinematics with anatomic anterior cruciate ligament (ACL) reconstruction, concerns regarding notch impingement of the graft have persisted, particularly with increasingly anterior tibial tunnel position. The potentially mitigating effect of anatomic femoral socket position, however, has not been evaluated.Hypothesis: Placement of the femoral socket in the central or posterolateral bundle footprint reduces the risk and

Travis G. Maak; Asheesh Bedi; Bradley S. Raphael; Musa Citak; Eduardo M. Suero; Thomas Wickiewicz; Andrew D. Pearle

2011-01-01

117

Proprioception after rehabilitation and reconstruction in knees with deficiency of the anterior cruciate ligament: a prospective, longitudinal study.  

PubMed

We assessed proprioception in the knee using the angle reproduction test in 20 healthy volunteers, ten patients with acute anterior instability and 20 patients with chronic anterior instability after reconstruction of the anterior cruciate ligament (ACL). In addition, the Lysholm-knee score, ligament laxity and patient satisfaction were determined. Acute trauma causes extensive damage to proprioception which is not restored by rehabilitation alone. Three months after operation, there remained a slight decrease in proprioception compared with the preoperative recordings, but six months after reconstruction, restoration of proprioception was seen near full extension and full flexion. In the mid-range position, proprioception was not restored. At follow-up, 3.7 +/- 0.3 years after reconstruction, there was further improvement of proprioception in the mid-range position. There was no difference between open and arthroscopic techniques. The highest correlation was found between proprioception and patient satisfaction. After reconstruction of the ACL reduced proprioception may explain the poor functional outcome in some patients, despite restoration of mechanical stability. PMID:10990300

Fremerey, R W; Lobenhoffer, P; Zeichen, J; Skutek, M; Bosch, U; Tscherne, H

2000-08-01

118

Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures  

PubMed Central

Objective A multifactorial combination of predictors may increase anterior cruciate ligament (ACL) injury risk in athletes. The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury. Methods Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using three-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity using a modified Beighton–Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction. Results Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings. Conclusions Prescreened mature female twins that subsequently experienced ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width.

Hewett, T E; Lynch, T R; Myer, G D; Ford, K R; Gwin, R C; Heidt, R S

2014-01-01

119

Can we use peroneus longus in addition to hamstring tendons for anterior cruciate ligament reconstruction?  

PubMed Central

Background: The aim of this study is to evaluate the possible effects of removing the peroneus longus on the ankle and gait parameters, in order to add insufficient hamstring tendons for anterior cruciate ligament (ACL) reconstruction. Materials and Methods: In this controlled clinical trial, 375 patients with ACL rupture who underwent ACL reconstruction arthroscopically using hamstring tendons in the orthopedic clinics of Isfahan University of Medical Sciences in 2010 and 2011 were selected. Fifteen patients were included because their hamstring tendon diameter was lower than 8 mm and peroneus longus was added. After 6 months, the patients were followed using “Kistler force plate” to detect 3D kinematics and kinetics of the ankles and spatiotemporal walking parameters. Results: There was a significant difference between both operated and non-operated ankles in flexion/extension range of motion (P < 0.05). There was no significant difference between the moments of both ankles in sagittal and coronal planes (P > 0.05), but there was a significant difference between the moments of both ankles in the transverse plane (P = 0.006). There was a significant difference in the force of operated and non-operated ankles in all three planes (P < 0.05). There was no significant difference in the mean values of spatiotemporal gait parameters between operated and non-operated sides (P > 0.05). Conclusion: Removing the peroneus longus tendon has no effect on gait parameters and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopedic surgeries.

Nazem, Khalilallah; Barzegar, Mohammadreza; Hosseini, Alireza; Karimi, Mohammadtaghi

2014-01-01

120

ORV Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures  

PubMed Central

Tibial eminence fractures are an uncommon but well-described avulsion of the anterior cruciate ligament. Treatment principles are based on the amount and pattern of fracture displacement. Management has evolved from closed reduction and immobilization to arthroscopic reduction and internal fixation followed by early rehabilitation. Various fixation methods have evolved, ranging from arthroscopic reduction and percutaneous screw fixation to arthroscopic suture repair. We present a technique for arthroscopic reduction and internal fixation using a cannulated drill bit and high-strength suture. This technique facilitates anatomic reduction with uncomplicated tunnel placement and suture passing in an effort to allow strong fixation and early rehabilitation.

Myer, Daniel M.; Purnell, Gregory J.; Caldwell, Paul E.; Pearson, Sara E.

2013-01-01

121

Landing Mechanics Between Noninjured Women and Women With Anterior Cruciate Ligament Reconstruction During 2 Jump Tasks  

PubMed Central

Background Women with anterior cruciate ligament reconstruction have different neuromuscular strategies than noninjured women during functional tasks after ligament reconstruction and rehabilitation. Hypothesis Landing from a jump creates high loads on the knee creating dynamic instability in women with anterior cruciate ligament reconstruction, whereas noninjured women have stable knee landing mechanics. Study Design Controlled laboratory study. Methods Fifteen noninjured women and 13 women with anterior cruciate ligament reconstruction performed 5 trials of a single-legged 40-cm drop jump and 2 trials of a 20-cm up-down hop task. Multivariate analyses of variance were used to compare hip and knee joint kinematics, knee joint moments, ground-reaction forces, and electromyographic findings between the dominant leg in noninjured women and reconstructed leg in women with anterior cruciate ligament reconstruction. Results No statistically significant differences between groups were found for peak hip and knee joint angles for the drop jump task. Statistically significant differences in neuromuscular activity (P = .001) and anterior-posterior knee shear forces (P < .001) were seen in women with anterior cruciate ligament reconstruction compared with noninjured women in the drop jump task. However, no statistically significant differences (P > .05) between groups were found for either peak hip and knee joint angles, peak joint kinetics, or electromyographic findings during the up-down hop task. Conclusion Women with anterior cruciate ligament reconstruction have neuromuscular strategies that allow them to land from a jump similar to healthy women, but they exhibit joint moments that could predispose them to future injury if they participate in sports that require jumping and landing.

Ortiz, Alexis; Olson, Sharon; Libby, Charles L.; Trudelle-Jackson, Elaine; Kwon, Young-Hoo; Etnyre, Bruce; Bartlett, William

2009-01-01

122

Novel anterior cruciate ligament graft fixation device reduces slippage.  

PubMed

Clinically significant laxity occurs in 10%-30% of knees after anterior cruciate ligament reconstruction. Graft slippage and tension loss at the hamstring graft tibial fixation site during and after reconstruction surgery contribute to postoperative joint laxity and are detrimental to long-term knee stability and graft properties. Limiting graft slippage will reduce associated complications. We sought to compare the in vitro mechanical properties and in vivo joint stabilization, postoperative limb use, and graft incorporation of the novel GraftGrab™ (GG) device designed to reduce hamstring graft tibial fixation slippage with the commercially available bioabsorbable Bio-Post™ and spiked washer (BP). Mechanical testing was performed on canine tibia-hamstring graft constructs to quantify initial fixation properties. In vivo joint stabilization, postoperative limb use and graft incorporation of hamstring graft reconstructions were determined in a canine model. Outcomes included tibial translation and ground reaction forces preoperatively and 4 and 8 weeks postoperatively, three-dimensional graft and bone tunnel dimensions at the latter two time points, and graft-bone microstructure, as well as mechanical properties 8 weeks after implantation. Immediately after fixation, all grafts slipped from the BP constructs versus about 30% of GG constructs. In vivo limb use remained low, and tibial translation increased with time in the BP cohort. These results together confirm that initial graft slippage is lower with GG versus BP extracortical hamstring graft tibial fixation. In addition, postoperative recovery and joint stability are more consistent with the GG. This information supports the GG as an alternative to extracortical tibial hamstring graft fixation that has procedural advantages over current implants and reduces graft failure from slippage. PMID:23717051

Lopez, Mandi J; Borne, Allen; Monroe, W Todd; Bommala, Prakash; Kelly, Laura; Zhang, Nan

2013-01-01

123

Anterior cruciate ligament repairs in world class skiers.  

PubMed

From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomitant extraarticular iliotibial band tenodesis. Twenty-seven knees (24 patients) were followed an average of 57.6 months postoperatively. Recreational skiing was resumed at 5.4 months on average, and in ski racing and pivot-requiring sports all but three patients resumed participation at an average of 9.1 months. In 78% of the knees there was pain-free function. Mild pain was reported in 19%, the majority of which (4/5) was related to vigorous activity. Of the total, only two knees were reported to have a sensation of giving way. On clinical examination 85% (23/27) had normal pivot shift examination with no evidence of abnormal motion. Four percent (1/27) had a 1+ test and 11% (3/27) had "glides." Arthrometer measurements revealed an average of 7.76 mm anterior displacement with 20 pounds of force on the knee with an ACL repair as compared to 5.56 mm on the uninjured knee. The laxity measurements of knees with repaired ACLs fell within the range reported for uninjured knees in the normal population. Five patients had reinjuries to the ACL at an average time of 28 months postoperatively, with two of five undergoing rerepair. Only one patient had an iliotibial band tenodesis to supplement the original ACL repair.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3674267

Higgins, R W; Steadman, J R

1987-01-01

124

Transphyseal reconstruction of the anterior cruciate ligament in prepubescent athletes.  

PubMed

ACL reconstruction in adolescents undergoing or being beyond the final growth spurt can be performed as in adults without major concern of growth disturbance. Whereas for the young athlete with wide-open physis a lot of controversy still exists about the technical aspect of the procedure to minimise the risk of growth disturbance. Between 10/1997 and 10/2002 31 children graded Tanner stage 1 or 2 (median age 11 years) with an intraligamental rupture of the anterior cruciate ligament were enrolled. Seventeen patients with coexisting intraarticular damage (meniscus, osteochondral flake) underwent transphsyeal reconstruction of the ACL with the use of an autogenous semitendinosus tendon graft, whereas 14 patients without coexisting pathologies received a nonoperative regime. Growth disturbance, functional and radiographic outcome could be evaluated in 28 patients at a median of 70 months after initial treatment. No patient had clinical or radiological evidence for varus/valgus malalignment or leg length discrepancy. The mean of subsequent body growth within the study population was 20.3 cm. Patients operated on revealed significant (P < 0.05) better clinical (KT-1000 side-to-side difference, pivot shift) and functional results according to the IKDC (median, 95 vs. 87), Lysholm (median, 93 vs. 84) and the Tegner score. More than half of the conservatively treated patients (58%) had subsequent surgery due to persistent instability. Transphyseal reconstruction of intraligamental ACL ruptures with an autologous ST graft yielded superior clinical results if compared to a nonoperative treatment in immature prepubescent patients being Tanner stage 1 and 2. PMID:20130837

Streich, Nikolaus A; Barié, Alexander; Gotterbarm, Tobias; Keil, Maximilian; Schmitt, Holger

2010-11-01

125

Anterior Cruciate Ligament Injury Prevention Training in Female Athletes  

PubMed Central

Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests. Objective: To determine if ACL injury prevention programs have a positive influence on both injury rates and athletic performance tests in female athletes. Data sources: In August 2011, a search was conducted (1995–August 2011) of the PubMed, Science Direct, and CINAHL databases. Study selection: Selected studies determined the effect of ACL intervention training programs on ACL incidence rates (determined by athlete-exposures) and athletic performance tests, such as isokinetic strength, vertical jump height, speed, agility, and dynamic balance. Because no single article contained both criteria, investigations were cross-referenced to obtain data on both factors from the same training programs. Data extraction: The authors reviewed the selected studies for cohort population numbers, age, sports, duration of study, program components, duration of training, number of athlete-exposures, ACL injury incidence rates, and results of athletic performance tests. Results: Initially, 57 studies were identified that described 42 ACL injury prevention training programs. Of these, 17 studies that investigated 5 programs met the inclusion criteria. Two programs significantly reduced ACL injury rates and improved athletic performance tests: Sportsmetrics and the Prevent Injury and Enhance Performance program (PEP). Sportsmetrics produced significant increases in lower extremity and abdominal strength, vertical jump height, estimated maximal aerobic power, speed, and agility. Prevent Injury and Enhance Performance significantly improved isokinetic knee flexion strength but did not improve vertical jump height, speed, or agility. The other 3 programs (Myklebust, the “11,” and Knee Ligament Injury Prevention) did not improve both ACL injury rates and athletic performance tests. Conclusions: Only the Sportsmetrics and PEP ACL intervention training programs had a positive influence on injury reduction and athletic performance tests.

Noyes, Frank R.; Barber Westin, Sue D.

2012-01-01

126

Function of the quadriceps and hamstrings muscles in knees with chronic partial deficiency of the anterior cruciate ligamentIsometric and isokinetic evaluation  

Microsoft Academic Search

We assessed the isokinetic and isometric strength and power profile of the knees of 37 patients who had a previous grade II sprain (partial tear) of the anterior cruciate ligament. Of the 37 knees, 11 had an isolated partial anterior cruciate ligament rupture and 26 had a partial anterior cruciate ligament rupture combined with a partial medial collateral ligament rupture.

Pekka Kannus; Markku Jarvinen; Robert Johnson; Per Renström; Malcolm Pope; Bruce Beynnon; Claude Nichols; Michael Kaplan

1992-01-01

127

Anterior Cruciate Ligament Injuries in Female AthletesPart 2, A Meta-analysis of Neuromuscular Interventions Aimed at Injury Prevention  

Microsoft Academic Search

Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The

Timothy E. Hewett; Kevin R. Ford; Gregory D. Myer

2006-01-01

128

Combined rupture of the patellar tendon, anterior cruciate ligament and lateral  

PubMed Central

Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct kick on his left knee. A two-stage treatment approach was performed with an excellent functional outcome.

Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

2011-01-01

129

Combined rupture of the patellar tendon, anterior cruciate ligament and lateral.  

PubMed

Simultaneous rupture of both the patellar tendon and the anterior cruciate ligament is a relatively rare injury. Its diagnosis can easily be missed during the initial examination. Treatment options include immediate repair of the patellar tendon with either simultaneous or delayed reconstruction of the ACL. We present the case of a combined rupture of the patellar tendon, the anterior cruciate ligament and the lateral meniscus in a 38-year old recreational martial arts athlete after a direct kick on his left knee. A two-stage treatment approach was performed with an excellent functional outcome. PMID:22110304

Tsarouhas, A; Iosifidis, M; Kotzamitelos, D; Traios, S

2011-04-01

130

Anatomical reconstruction of the anterior cruciate ligament in goats.  

PubMed

A surgical procedure was developed for the implantation of an anatomical, two-banded anterior cruciate ligament (ACL) prosthesis. Prostheses were fabricated of braided long-chain polyethylene fibers. The left ACL of adult male goats was surgically excised and replaced with either an anatomical reconstruction (5 goats) or a conventional reconstruction (5 goats). The anatomical reconstruction required drilling four bone tunnels, two each in the femur and tibia. Each band of the prosthesis was placed through one tunnel in the femur and the corresponding tunnel in the tibia, recreating the anteromedial and posterolateral bands. The two bands were tensioned independently and stapled in place. In the conventional procedure, the prosthesis was doubled and placed through two larger tunnels, one in the femur and one in the tibia, tensioned and stapled together. All animals were terminated 3 months after surgery. Clinical evaluation of passive range of motion, antero-posterior laxity and the appearance of the joint space showed little or no difference between the reconstruction methods. The ultimate failure load for the natural (unoperated) ACL was 1691 +/- 210 N, while the anatomical and conventional reconstruction groups had mean ultimate failure loads of 1233 +/- 732 and 1012 +/- 220 N, respectively. The elongation to failure of all groups was similar: the natural ACL group = 7.1 +/- 2.8 mm, the anatomical group = 7.2 +/- 2.9 mm, and the conventional group = 7.7 +/- 3.9 mm. The slope of the load-deformation curve, or stiffness, was significantly higher for the natural ACL (4.53 +/- 1.24 x 10(5) N/m) than for either of the reconstruction methods (2.75 +/- 1.59 x 10(5) N/m for the anatomical and 2.34 +/- 0.60 x 10(5) N/m for the conventional). The energy to failure, or area under the load-deformation curve, showed no significant difference between groups. In conclusion, both types of reconstructions were less strong, stiff, and tough than the natural ACL. There was no significant difference observed between the anatomical and conventional reconstruction methods over the 3-month implantation time in either clinical evaluation or mechanical testing. Therefore, at 3 months postsurgery, the anatomical reconstruction technique was considered no better and no worse than the conventional reconstruction technique. PMID:2069929

Powers, D L; Jacob, P A; Drews, M J

1991-01-01

131

Prospective Comparative Study of Anterior Cruciate Ligament Reconstruction Using the Double-Bundle and Single-Bundle Techniques  

PubMed Central

Background The intent of double-bundle anterior cruciate ligament reconstruction is to reproduce the normal anterior cruciate ligament anatomy and improve knee joint rotational stability. However, no consensus has been reached on the advantages of this technique over the single-bundle technique. Hypothesis We hypothesized that double-bundle anterior cruciate ligament reconstruction could provide better intraoperative stability and clinical outcome than single-bundle reconstruction. Type of study Cohort study; Level of evidence, 2. Methods Forty patients with anterior cruciate ligament injury in one knee were recruited; 20 were allocated to a double-bundle anterior cruciate ligament reconstruction group and 20 to a single-bundle anterior cruciate ligament reconstruction group. Intraoperative stabilities at 30° of knee flexion were compared between the 2 groups using a navigation system. Clinical outcomes including Lysholm knee scores, Tegner activity scores, Lachman and pivot-shift test results, and radiographic stabilities were also compared between the 2 groups after a minimum of 2 years of follow-up. Results Intraoperative anterior and rotational stabilities after anterior cruciate ligament reconstruction in the double-bundle group were significantly better than those in single-bundle group (P = .020 and P < .001, respectively). Nineteen patients (95%) in each group were available at a minimum 2-year follow-up. Clinical outcomes including Lysholm knee and Tegner activity scores were similar in the 2 groups at 2-year follow-up (P > .05). Furthermore, stability results of the Lachman and pivot-shift tests, and radiologic findings at 2-year follow-up failed to reveal any significant intergroup differences (P > .05). Conclusion Although double-bundle anterior cruciate ligament reconstruction produces better intraoperative stabilities than single-bundle anterior cruciate ligament reconstruction, the 2 modalities were found to be similar in terms of clinical outcomes and postoperative stabilities after a minimum of 2 years of follow-up.

Song, Eun Kyoo; Oh, Luke S.; Gill, Thomas J.; Li, Guoan; Gadikota, Hemanth R.; Seon, Jong Keun

2013-01-01

132

Meniscus repair in the anterior cruciate deficient knee  

Microsoft Academic Search

From 1979 to 1986, isolated repair of a peripheral vascular zone meniscal tear was performed in 22 pa tients (23 menisci) who had ACL insufficiency. For various reasons none of these patients underwent re pair or reconstruction of their ACL. The meniscus repair was done by open arthrotomy in 12 cases and by arthroscopic techniques in 11 cases. The purpose

Gregory A. Hanks; Trenton M. Gause; John A. Handal; Alexander Kalenak

1990-01-01

133

Single– versus two–femoral socket anterior cruciate ligament reconstruction technique  

Microsoft Academic Search

Purpose: Although anterior cruciate ligament (ACL) reconstruction with multistrand autogenous hamstring tendons has been widely performed using a single femoral socket (SS), it is currently advocated to individually reconstruct 2 bundles of the ACL using 2 femoral sockets (TS). However, the difference in biomechanical characteristics between them is unknown. The objective of this study was to clarify their biomechanical differences.

Tatsuo Mae; Konsei Shino; Takahide Miyama; Hirotaka Shinjo; Takahiro Ochi; Hideki Yoshikawa; Hiromichi Fujie

2001-01-01

134

A tenosynovial giant cell tumor arising from femoral attachment of the anterior cruciate ligament.  

PubMed

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man. PMID:24900909

Lee, Ju-Hong; Wang, Seong-Il

2014-06-01

135

Biomechanics of anterior cruciate ligament reconstruction using twisted doubled hamstring tendons  

Microsoft Academic Search

We studied the biomechanical properties of a twisted doubled semitendinosus and gracilis graft. We applied an un-axial load in order to reproduce the kinematics of a reconstructed anterior cruciate ligament (ACL). A modified cryo-jaw clamp system was used to minimize soft tissue slippage. The lower grip, after fixation of the free ends of the tendons, was rotated 45°, translated 1

A. Ferretti; F. Conteduca; F. Morelli; L. Monteleone; F. Nanni; M. Valente

2003-01-01

136

Acute repair of injury to the anterior cruciate ligamentA long-term followup  

Microsoft Academic Search

We reviewed 30 patients at an average of 7.4 years after acute repair of the anterior cruciate ligament aug mented with a loop of iliotibial tract. A noncontact twisting had been the mechanism of injury in 18 of these patients, with 28 having been injured in sports. At followup, 25 patients had not experienced symptoms of instability and 23 were

Mervyn J. Cross; J. R. Wootton; Desmond J. Bokor; Sam J. Sorrenti

1993-01-01

137

Regeneration of the Semitendinosus Tendon Harvested for Anterior Cruciate Ligament ReconstructionEvaluation Using Ultrasonography  

Microsoft Academic Search

In a prospective study, 40 consecutive patients who underwent anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendon autografts were examined pre- and postoperatively by ultrasound to investigate the anatomy of the donor site before and after the harvest of the tendons. The patients underwent ultrasonography at 2 weeks and 1, 2, 3, 6, 12, 18, and 24 months

Paola Papandrea; Maria Chiara Vulpiani; Andrea Ferretti; Fabio Conteduca

2000-01-01

138

Biocompatibility of polyethylene terephthalate (Trevira ® hochfest) augmentation device in repair of the anterior cruciate ligament  

Microsoft Academic Search

The biocompatibility of a 3mm band made of polyethylene terephthalate (Trevira® hochfest) has been tested in an experimental study within right knee joints of 60 sheep. After transsecting the anterior cruciate ligament (ACL), two randomized groups were formed. In group I, the ACL was repaired according to the Marshall technique whilst in group II an additional 3mm polyethylene terephthalate (PET)

Helmut Seitz; Stefan Marlovits; Ilse Schwendenwein; Elisabeth Müller; Vilmos Vécsei

1998-01-01

139

Return to Play After Anterior Cruciate Ligament Reconstruction in National Football League Athletes  

Microsoft Academic Search

Background: Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-threatening injury in the National Football League (NFL). The return to play (RTP) percentage and the factors affecting RTP after ACL reconstruction in NFL players are not well defined.Purpose: To determine the actual rate of return to professional football play in the NFL after ACL reconstruction surgery

Vishal M. Shah; James R. Andrews; Glenn S. Fleisig; Christopher S. McMichael; Lawrence J. Lemak

2010-01-01

140

Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk  

Microsoft Academic Search

Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli

Marcus J. C. Lee; Paul Bourke; Jacqueline A Alderson; David G Lloyd; Brendan Lay

141

Anterior cruciate ligament reconstruction using a composite collagenous prosthesis. A biomechanical and histologic study in rabbits.  

PubMed

We evaluated a prototype composite collagenous anterior cruciate ligament replacement device designed to possess the advantages of biological grafts and synthetic materials. Collagenous anterior cruciate ligament prostheses were made by embedding 225 reconstituted type I collagen fibers in a type I collagen matrix, and placing polymethylmethacrylate bone fixation plugs on the ends. The collagenous prosthesis was used to replace the anterior cruciate ligament of 31 mature rabbits. At 4 and 20 weeks postimplantation, histologic and mechanical studies were performed on the developing neoligament tissue, and compared to values for the contralateral sham-operated control. At 4 weeks, neoligament tissue infiltrated the collagen fibers of the prostheses. The tibial bone tunnel attachment site contained new bone approaching the fibrous neoligament. The glutaraldehyde-treated prosthetic fibers appeared intact, while the carbodiimide-treated prosthetic fibers began to resorb. The ultimate load and ultimate tensile strength of femur-neoligament-tibia complexes had decreased. At 20 weeks, glutaraldehyde-treated fibers appeared partially intact; in contrast, the carbodiimide-treated prostheses appeared to be completely degraded, and were replaced by organized, crimped neoligament tissue. The ultimate tensile strength and ultimate load increased substantially due to deposition and remodeling of neoligament tissue. The neoligament ultimate load was 2 to 4 times the initial load value of the prosthesis. Implantation of a resorbable, composite collagenous anterior cruciate ligament prosthesis encourages the development of functional neoligament tissue. Studies are underway to optimize the mechanical and biological properties of the prostheses. PMID:1443316

Dunn, M G; Tria, A J; Kato, Y P; Bechler, J R; Ochner, R S; Zawadsky, J P; Silver, F H

1992-01-01

142

Proteoglycan fragments in anterior cruciate ligament reconstructed knees: a comparative study of two different surgical techniques  

Microsoft Academic Search

Proteoglycan fragments (PF) as chondroitin sulphate were monitored and compared in two groups of patients who had anterior cruciate ligament reconstruction with either patellar tendon (PT) or quadruple semitendinosus tendon (ST) autografts. There were 20 ST and 21 PT reconstructions. No difference existed between the groups in terms of associated lesion and time from injury to surgery. Synovial sample was

Emin Taskiran; Dilek Taskiran; Veli Lok

2005-01-01

143

A model of soft-tissue graft anterior cruciate ligament reconstruction in sheep  

Microsoft Academic Search

Introduction Since there is to our knowledge no clinically valid and reproducible animal model of soft-tissue anterior cruciate ligament (ACL) recon- struction currently available, we developed one in sheep, in terms of graft suitability, postsurgical recovery, and knee stability. Materials and methods To find a suitable graft, anatomical dissections of the hind limbs of 7 sheep were performed. After a

Patrick Hunt; Sven U. Scheffler; Frank N. Unterhauser; Andreas Weiler

2005-01-01

144

Joint position sense and rehabilitation in the anterior cruciate ligament deficient knee  

Microsoft Academic Search

BACKGROUND: Impaired joint position sense (JPS) has been shown in anterior cruciate ligament (ACL) deficient and osteoarthritic knees. The relation between JPS and function is uncertain. The aim of this study was to determine further if ACL deficient knees show abnormal JPS and the effect of exercise therapy on JPS, and also to assess the relation between JPS, functional stability,

N D Carter; T R Jenkinson; D Wilson; D W Jones; A S Torode

1997-01-01

145

Development of Robotic Assistive Surgery System for Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Reconstruction surgery for an Anterior Cruciate Ligament (ACL) is becoming increasingly popular, due to the increase in people engaging in sport. In this surgery, four bone tunnels are drilled in the femur and tibia respectively, following which two substitute ligaments extracted from the other part of body, so called grafts, are inserted and fixed to both bones. However, although this

Masahiro Hirabayashi; Nobuaki Hayashi; Jun Okamoto; Masakatsu G. Fujie; Hirotsugu Muratsu; Masahiro Kurosaka

2006-01-01

146

Implementation of Open and Closed Kinetic Chain Quadriceps Strengthening Exercises after Anterior Cruciate Ligament Reconstruction.  

ERIC Educational Resources Information Center

Reviews the effects of open kinetic chain (OKC) and closed kinetic chain (CKC) exercise on anterior cruciate ligament (ACL) strain and patellofemoral joint stress, suggesting a combination of the two for quadriceps strengthening after ACL reconstruction. Both OKC and CKC exercises may be modified and implemented for quadriceps strengthening after…

Ross, Michael D.; Denegar, Craig R.; Winzenried, Jay A.

2001-01-01

147

Anterior cruciate ligament regeneration using mesenchymal stem cells and silk scaffold in large animal model  

Microsoft Academic Search

Although in vivo studies in small animal model show the ligament regeneration by implanting mesenchymal stem cells (MSCs) and silk scaffold, large animal studies are still needed to evaluate the silk scaffold before starting a clinical trial. The aim of this study is to regenerate anterior cruciate ligament (ACL) in pig model. The micro-porous silk mesh was fabricated by incorporating

Hongbin Fan; Haifeng Liu; Siew L. Toh; James C. H. Goh

2009-01-01

148

Early histologic, metabolic, and vascular assessment of anterior cruciate ligament autografts  

SciTech Connect

A rabbit model for anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon was utilized to study the early events of autograft cellular dynamics. Biochemical, autoradiographic, histological, and vascular injection techniques demonstrated that the native autograft cell population rapidly necroses. This repopulation occurs without a vascular contribution; cells entering the autograft are reliant upon synovial fluid nutrition.

Kleiner, J.B.; Amiel, D.; Harwood, F.L.; Akeson, W.H.

1989-01-01

149

A Tenosynovial Giant Cell Tumor Arising from Femoral Attachment of the Anterior Cruciate Ligament  

PubMed Central

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.

Lee, Ju-Hong

2014-01-01

150

Training for Women's Basketball: A Biomechanical Emphasis for Preventing Anterior Cruciate Ligament Injury.  

ERIC Educational Resources Information Center

Summarizes proposed variables linked with higher incidences of anterior cruciate ligament tears in females and the biomechanical aspects of the lower extremity during the performance of common basketball skills, focusing on gender differences in knee joint stability and neuromuscular control, biomechanical aspects of lower extremity skills in…

Pettitt, Robert W.; Bryson, Erin R.

2002-01-01

151

Anterior Cruciate Ligament Injury Incidence Among Male and Female Professional Alpine Skiers  

Microsoft Academic Search

A retrospective review of anterior cruciate ligament injuries among professional alpine skiers was performed to compare sex-related differences in injury incidence. We screened 7155 ski patrollers or instructors (4537 men and 2618 women) for knee injuries before each ski season between 1991 and 1997. Screening involved a ski history questionnaire, a knee injury history questionnaire, and a knee physical examination.

Randall W. Viola; J. Richard Steadman; Scott D. Mair; Karen K. Briggs; William I. Sterett

1999-01-01

152

Leg Dominance Is a Risk Factor for Noncontact Anterior Cruciate Ligament Injuries in Female Recreational Skiers  

Microsoft Academic Search

Background: In recreational alpine skiing, the knee joint accounts for about one third of all injuries in male and female skiers. However, female recreational skiers have twice the knee injury incidence of male skiers, and the anterior cruciate ligament (ACL) injury risk is 3 times greater in female skiers.Purpose: To evaluate whether leg dominance is a risk factor for noncontact

Gerhard Ruedl; Magdalena Webhofer; Kenneth Helle; Martin Strobl; Alois Schranz; Christian Fink; Hannes Gatterer; Martin Burtscher

2012-01-01

153

A new technique of arthroscopic capsular shift in anterior shoulder instability.  

PubMed

We describe a new arthroscopic technique to reinforce the torn inferior glenohumeral ligament (IGHL) and the elongated capsule to the glenoid rim. The arthroscope is inserted over the superior portal and, after the insertion of a suture anchor, both limbs are pulled out over the posterior portal. The IGHL is grasped and pulled upward onto the glenoid rim using a suture retriever clamp inserted over the posterior portal. A 45 degrees curved blunt clamp (Sidewinder; Arthrex, Naples, FL) coming from the anterior penetrates the IGHL, and 1 end of the suture limb is given into the branches of the clamp and pulled out anteriorly. After a second perforation of the capsule, a horizontal suture creating a neolabrum can be placed. This technique allows a suitable reinforcement of the capsule without intraoperative complications. In cases of capsular elongation, especially a torn IGHL, the capsular instability can be addressed by the described Sidewinder technique. More sophisticated arthroscopic techniques such as this will increase the indication for arthroscopic shoulder stabilization. PMID:11288020

Nebelung, W; Röpke, M; Urbach, D; Becker, R

2001-04-01

154

Systematic Review of Arthroscopic Versus Open Repair for Recurrent Anterior Shoulder Dislocations  

PubMed Central

Context: It remains unknown if arthroscopic repair of recurrent anterior shoulder instability is as effective as open repair. Objective: The purpose of this study is to analyze the literature to provide clinical recommendations regarding the most appropriate therapeutic intervention for recurrent anterior shoulder instability. Study Design: Systematic review of level I and II studies. Data Sources: PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and secondary references from 1967 to March 2010 were appraised for studies that met the inclusion criteria. Study Selection: Inclusion criteria were English-language level I or level II trials involving the treatment of recurrent anterior shoulder instability. Exclusion criteria included non-English-language studies; level III, IV, or V studies; and trials examining treatment of first-time shoulder dislocation, posterior shoulder dislocation, or diagnoses other than recurrent anterior shoulder dislocations. Data Extraction: Included studies underwent quality appraisal independently by each author identifying strengths, weaknesses, and biases. Results: Four randomized controlled trials compared the use of arthroscopic and open repair for recurrent anterior shoulder dislocations. These studies show no statistically significant difference between the 2 operative approaches. No long-term follow-up data describing the effects of either surgical approach are available at this time. Each investigation had weaknesses in study design that decreased the validity of its findings. Conclusions: While limited, the available evidence from randomized controlled trials does not show a statistically significant difference in redislocation rates, return to activity, and functional outcomes between the arthroscopic and open repair groups. Range of motion is marginally better following arthroscopic treatment when compared with open repair. Recommendations on the optimal surgical intervention cannot be provided.

Godin, Jonathan; Sekiya, Jon K.

2011-01-01

155

Anterior cruciate ligament repairs in world class skiers  

Microsoft Academic Search

From 1979 to 1984, 27 skiers who were either present or past members of the United States Ski Team or professional skiers had 30 ACL tears that were repaired primarily. Only two of the repairs were augmented with autogenous patellar tendon grafts. Five patients had complete knee dislocations, including tears of both cruciate ligaments. Nineteen patients had a concomi tant

R. W. Higgins; J. R. Steadman

1987-01-01

156

Anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon - minimum 6 year clinical and radiological follow-up.  

PubMed

This clinical study evaluates the minimum 6 year follow-up clinical, functional, radiological and isometric results after arthroscopic reconstruction of the anterior cruciate ligament (ACL) with quadrupled semitendinosus tendon autograft (femoral endobutton and tibial suture disc fixation). Seventy out of 85 operated patients (lost to follow-up 17%) with an average age of 34.3 years could be clinically examined at a mean follow-up time of 6 years and 4 months after surgery. Results revealed a high subjective satisfaction rate of 93%. The preoperative activity level could be maintained in 71% of the patients. The Lysholm score showed very good and good results in 85% with a mean of 83.6%. Normal or nearly normal results on the IKDC score were reported in 85% of the patients. The KT-1000 arthrometer stability testing showed a difference of less than 3 mm compared to the contralateral knee in 75% of the patients. Five patients (7%) had a graft failure during follow-up time. There were no or only mild degenerative changes at the radiographic evaluation in 85% of the patients. In 15% of the patients a femoral and in 40% a tibial tunnel widening of more than 50% was observed, however without a relevance for the clinical and functional status. Midterm results obtained in this study after arthroscopic ACL reconstruction with the quadrupled semitendinosus tendon confirm the outcomes in the literature after shorter follow-up periods that provide very good and good subjective, functional and stability results in about 80-85% of the patients. This surgical technique can be recommended for the active patient with ACL deficiency. However, patients must be informed that activity level cannot always be maintained and a failure rate of 5-10% must be taken into account in the longer term when decision for surgery is made. PMID:17512735

Buchner, Matthias; Schmeer, Thorsten; Schmitt, Holger

2007-08-01

157

[Arthroscopic reconstruction of the capsule-ligament using Landsiedl's technique for treating recurrent anterior shoulder dislocation].  

PubMed

Landsiedl arthroscopic capsuloligamentous reconstruction in treatment for recurrent anterior dislocation of the shoulder has been performed in 48 patients with follow-up between 6 months and 3 years. High efficacy and insignificant invasiveness make the method attractive. The success is secured by precise location of the canal for sutures within the neck of the scapula. It should be located in the original attachment of the lower glenohumeral ligament. PMID:9102236

Pawlas, R; Pajak, J; Chrobok, A; Smolik, M

1996-01-01

158

Football Cleat Design and Its Effect on Anterior Cruciate Ligament InjuriesA Three-Year Prospective Study  

Microsoft Academic Search

A 3-year prospective study was initiated to evaluate torsional resistance of modern football cleat designs and the incidence of surgically documented anterior cruciate ligament tears in high school football players wearing different cleat types. We compared four styles of football shoes and evaluated the incidence of ante rior cruciate ligament tears among 3119 high school football players during the 1989

Rick B. Lambson; Bill S. Barnhill; Robert W. Higgins

1996-01-01

159

Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique.  

PubMed

The goal of this study was to retrospectively evaluate the clinical outcomes of arthroscopic repair for chronic ankle instability using a bioabsorbable anchor with 2 sutures. We evaluated the results of 28 ankles treated with arthroscopic anterior talofibular ligament repair using bioabsorbable anchors with a FiberWire and TigerWire suture (Arthrex, Inc, Naples, Florida) placed on the fibula from March 2008 to January 2009. Average follow-up was 15.9 months (range, 13-25 months). Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot ankle score and stress radiographs. Mean AOFAS hindfoot ankle score was 92.48 ± 6.14 at last follow-up compared to the mean preoperative score of 60.78 ± 16.38 (P=.041). Mean postoperative anterior draw test score difference between 2 ankles was 0.61 ± 0.75 compared to the mean preoperative score difference of 3.59 ± 0.68 (P=.00). There was a 14% complication rate, including 3 cases of portal site irritation and 1 case of superficial infection. Stress radiographs revealed 3 cases of anterior displacement >3 mm compared to the other side. All patients returned to their previous activity level.Arthroscopic ligament reconstruction for chronic lateral ankle instability using suture anchors is effective in returning patients to their preinjury function levels. Good clinical results were obtained with some minor complications. This minimally invasive technique is a reasonable alternative to other open surgical procedures for chronic ankle instability. PMID:21469637

Kim, Eung Soo; Lee, Kyung Tai; Park, Jun Sic; Lee, Young Koo

2011-04-01

160

Femoral tunnel defect filled with a synthetic dowel graft for a single-staged revision anterior cruciate ligament reconstruction.  

PubMed

Bone defects are a common obstacle to successful revision anterior cruciate ligament (ACL) reconstruction. We describe the use of a synthetic bone graft plug to fill a cylindric defect after femoral interference screw removal. During revision ACL reconstruction performed through a 2-incision technique, we placed an outside-in guidewire for a new femoral tunnel that converged with the femoral screw from the primary ACL reconstruction. The screw was removed, and the resultant defect appeared very similar to the cylindric bone defect left after an osteochondral graft harvest. The confluence of the defect and the planned femoral tunnel would have allowed a "windshield wiper" effect of the graft at the lateral wall of the notch. We filled the screw defect with a synthetic bone graft plug to limit the aperture size of the femoral tunnel and to buttress the tendinous portion of the revision ACL graft, while maintaining proper anatomic graft position. In this article, we present a readily available all-arthroscopic option for repairing cylindric bone defects without the risk of an allograft or the morbidity of an autograft for a single-stage revision ACL reconstruction. PMID:17637422

Barrett, Gene R; Brown, Taylor D

2007-07-01

161

Longitudinal effects of anterior cruciate ligament injury and patellar tendon autograft reconstruction on neuromuscular performance.  

PubMed

We examined persons after anterior cruciate ligament injury and for 1.5 years after anterior cruciate ligament reconstruction to analyze changes in anterior knee laxity, lower extremity muscle strength, endurance, and several parameters of neuromuscular function. Sixteen men and nine women (average age, 23.8 years) were evaluated preoperatively, then underwent intraarticular autogenous patellar tendon anterior cruciate ligament reconstruction by the same surgeon and were evaluated at 6, 12, and 18 months postoperatively. Muscle strength was measured isokinetically and neuromuscular function was quantified with simultaneous anterior tibial translation and surface electromyography tests. Forty subjects (26 men and 14 women; average age, 23.5 years) with no known knee abnormalities served as the control group. Subjective questionnaire results showed that by 18 months postoperatively, 20 subjects (80%) believed they had regained their preoperative levels of function. Unfortunately, muscle function in most subjects had not returned to normal. At 12 to 18 months postoperatively, when knee rehabilitation was terminated, significant deficiencies in muscle performance persisted in most patients. Interestingly, in this group of stable knees, quadriceps and hamstring muscle reaction times appeared to be the best objective indicators of subjective knee function. PMID:10843124

Wojtys, E M; Huston, L J

2000-01-01

162

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique  

PubMed Central

We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70° arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction.

Ahn, Jin Hwan; Lee, Yong Seuk; Lee, Seung Hee

2014-01-01

163

Arthroscopic Capsulolabral Reconstruction of the Type VIII Superior Labrum Anterior Posterior LesionMean 2Year Follow-up on 13 Shoulders  

Microsoft Academic Search

Background: A type VIII superior labrum anterior posterior lesion represents pathologic posteroinferior extension of a type II superior labrum anterior posterior lesion with injury to the insertion of the posterior band of the inferior glenohumeral ligament. No reports in the literature describe arthroscopic treatment of a type VIII superior labrum anterior posterior lesion and its associated glenohumeral instability.Hypothesis: Arthroscopic capsulolabral

Shane Seroyer; Samir G. Tejwani; James P. Bradley

2007-01-01

164

Postoperative Analgesia Using PSOAS Sheath Block Versus Three-in-One Block in Anterior Cruciate Ligament Reconstruction.  

National Technical Information Service (NTIS)

In this study, the effects of two regional anesthetic techniques on postoperative pain of patients undergoing anterior cruciate ligament reconstruction surgery were described. Patients were assigned the morning of surgery to one of two groups. Subjects in...

C. A. Burch

1999-01-01

165

Long term results of anterior cruciate ligament reconstruction with iliotibial tract: 6-, 13-, and 24-year longitudinal follow-up  

Microsoft Academic Search

Many studies have reported successful outcomes less than 10 years after anterior cruciate ligament (ACL) reconstruction. However, longer-term outcomes have not been analyzed. We assessd outcomes 24 years after anterior cruciate ligament reconstruction with iliotibial tract and compared them with shorter-term results in the same patients. Between 1979 and 1981, 45 patients underwent combined intra- and extra-articular ACL reconstruction with iliotibial tract.

Satoshi Yamaguchi; Takahisa Sasho; Akihiro Tsuchiya; Yuichi Wada; Hideshige Moriya

2006-01-01

166

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes  

Microsoft Academic Search

Background: Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men.Purpose: To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury.Study Design: Case control study; Level of evidence,

Gregory D. Myer; Kevin R. Ford; Mark V. Paterno; Todd G. Nick; Timothy E. Hewett

2008-01-01

167

Anatomic Outside-In Anterior Cruciate Ligament Reconstruction Using a Suspension Device for Femoral Fixation  

PubMed Central

Cortical suspension is one of the most frequently used methods of femoral fixation in anterior cruciate ligament reconstruction. We present a simple technique for anterior cruciate ligament reconstruction using a suspension device for femoral fixation. The purposes of this technique are to ensure greater contact between the graft and the tunnel walls—a goal that is achieved by using the femoral fixation device with the shortest possible loop—to avoid the flip step and the need for hyperflexion, and in short, to minimize the risk of complications that can occur when using the anteromedial portal to drill the femoral tunnel. To this end, both the femoral and tibial tunnels are created in an outside-in manner and with the same guide. The graft is passed through in a craniocaudal direction, and the suspension device is fitted inside an expansion piece for a better adaptation to the femoral cortex.

Espejo-Baena, Alejandro; Espejo-Reina, Alejandro

2014-01-01

168

Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique  

PubMed Central

There is growing evidence that anatomic placement of the femoral tunnel in anterior cruciate ligament reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic anterior cruciate ligament reconstruction has many well-described technical challenges. This article describes the translateral all-inside technique, which produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and outside-in drilling. All work is carried out through the lateral portal with all viewing through the medial portal. Thus there is no need for an accessory medial portal or hyperflexion of the knee during femoral socket preparation. A single quadrupled hamstring graft is used with cortical fixation at both the femoral and tibial tunnels.

Wilson, Adrian J.; Yasen, Sam K.; Nancoo, Tamara; Stannard, Roger; Smith, James O.; Logan, James S.

2013-01-01

169

Longitudinal Assessment of Noncontact Anterior Cruciate Ligament Injury Risk Factors During Maturation in a Female Athlete: A Case Report  

PubMed Central

Objective: To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. Background: In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. Differential Diagnosis: Partial or complete tear of the ACL. Measurements: The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. Findings: The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. Conclusions: During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.

Myer, Gregory D; Ford, Kevin R; Divine, Jon G; Wall, Eric J; Kahanov, Leamor; Hewett, Timothy E

2009-01-01

170

Stability comparison of anterior cruciate ligament between double- and single-bundle reconstructions  

Microsoft Academic Search

The purpose of this study was to evaluate the intra-operative stability during double-bundle anterior cruciate ligament (ACL)\\u000a reconstructions (20 knees) using a navigation system and compare the results with those obtained from single-bundle reconstructions\\u000a (20 knees). After registering the reference points during ACL reconstruction, antero-posterior and rotational stability tests\\u000a with 30° knee flexion using a navigation system were measured before

Jong Keun Seon; Sang Jin Park; Keun Bae Lee; Taek Rim Yoon; Hyoung Yeon Seo; Eun Kyoo Song

2009-01-01

171

Intraarticular stabilization after anterior cruciate ligament tear in children and adolescents: results 6 years after surgery  

Microsoft Academic Search

Tear of the anterior cruciate ligament (ACL) secondary to knee sprain injury is also quite common among children and adolescents.\\u000a Whether reconstruction is indicated and which technique should be employed is still controversial. The debate focuses on the\\u000a possible risk of growth plate damages due to intraarticular operative reconstruction techniques. For more details on benefit\\u000a and risks of operative stabilization,

H. M. Gaulrapp; J. Haus

2006-01-01

172

A new positioning device for precise femoral insertion of the anterior cruciate ligament autograft  

Microsoft Academic Search

Optimal anatomical replacement of anterior cruciate ligament (ACL) is essential for achieving knee stability. Several methods\\u000a for localizing a correct center of femoral insertion of the ACL graft and identifying a center of the femoral tunnel have\\u000a been proposed, including free-hand drilling with “eyeballing,” the use of tensiometers or isometers, fluoroscopic or radioscopic\\u000a control, and aiming devices. We present a

Miroslav Milankov; N. Miljkovic

2000-01-01

173

Histological changes and apoptosis of cartilage layer in human anterior cruciate ligament tibial insertion after rupture  

Microsoft Academic Search

The purpose of this study is to investigate the histological changes and apoptosis of cartilaginous layers in human anterior\\u000a cruciate ligament (ACL) tibial insertion at different time periods after rupture. By using a core reamer, 35 tibial insertions\\u000a of ruptured ACLs were obtained during primary ACL reconstructions (number of days after injury: 19–206 days). A histological\\u000a examination was performed and a

Hirotaka Mutsuzaki; Masataka Sakane; Kotaro Ikeda; Tomoo Ishii; Shinya Hattori; Junzo Tanaka; Naoyuki Ochiai

2007-01-01

174

Methicillin-Resistant Staphylococcus aureus–Induced Septic Arthritis After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

We encountered a case of methicillin-resistant Staphylococcus aureus (MRSA)–induced septic arthritis after anterior cruciate ligament (ACL) reconstruction. A 20-year-old woman underwent left double-bundle ACL reconstruction by use of the hamstring tendon 18 months after her injury. She had a fever higher than 39°C, and swelling of the left knee developed on day 5 after surgery. The white blood cell count

Kazutoshi Kurokouchi; Shigeo Takahashi; Tomofumi Yamada; Hideki Yamamoto

2008-01-01

175

A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery  

Microsoft Academic Search

Objective:To determine whether the psychological characteristics of athletes who have undergone an anterior cruciate ligament (ACL) reconstruction change during rehabilitation are related to returning to competitive sport.Design:Prospective longitudinal study.Method:87 athletes completed the Emotional Response of Athletes to Injury Questionnaire (ERAIQ) and the ACL Return to Sport after Injury scale (ACL-RSI) at 3, 6 and 12 months following ACL reconstruction surgery.

J L Langford; K E Webster; J A Feller

2009-01-01

176

No-Tunnel Anterior Cruciate Ligament Reconstruction: The Transtibial All-Inside Technique  

Microsoft Academic Search

The purpose of this technical note is to describe the transtibial all-inside anterior cruciate ligament (ACL) reconstruction technique. This technique combines the advantages of previously described but technically demanding all-inside ACL reconstruction techniques with the ease and familiarity of transtibial guide pin placement. The all-inside technique uses bone sockets as opposed to bone tunnels in both the femur and the

James H. Lubowitz

2006-01-01

177

Intraoperative complications using the Bio-Transfix femoral fixation implant in anterior cruciate ligament reconstruction  

Microsoft Academic Search

The use of biodegradable Transfix femoral fixation technique is a safe and well-accepted method when performing anterior cruciate\\u000a ligament reconstruction. We report on three cases of deformation and back out of the Bio-Transfix implant over the lateral,\\u000a distal femoral cortex, with failure of the passing wire when advancing the graft into the femoral tunnel in one of these patients.\\u000a Two

Michail Kokkinakis; Alexander Ashmore; Magdi El-Guindi

2010-01-01

178

Double-bundle anatomic anterior cruciate ligament reconstruction using bone-hamstring-bone composite graft  

Microsoft Academic Search

The bone-hamstring-bone (BHB) composite graft is a hybrid ligament reconstruction methodology that combines the advantages but eliminates the disadvantages of the bone-patellar tendon-bone (BPTB) and tendon of semitendinosus and gracilis muscle (STG) methods. We have developed an innovative modified BHB method involving anatomic anterior cruciate ligament (ACL) reconstruction. It takes into account the 2 bundles of the ACL: the anteromedial

Ryohei Takeuchi; Tomoyuki Saito; Sigeyuki Mituhashi; Eiichi Suzuki; Ikufumi Yamada; Tomihisa Koshino

2002-01-01

179

Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon  

PubMed Central

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures.

Lee, Gwang Chul; Park, Sung-Hae

2014-01-01

180

The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis  

Microsoft Academic Search

This study evaluates the diagnostic accuracy of anterior cruciate ligament (ACL) rupture using magnetic resonance imaging\\u000a in the management of patients with symptomatic tibiofemoral instability. Published and unpublished databases including the\\u000a Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED and CINAHL, as well as unpublished studies registers were searched for studies that compared the diagnostic findings\\u000a of MRI to

T. O. Smith; M. Lewis; F. Song; A. P. Toms; S. T. Donell; C. B. Hing

181

Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature  

Microsoft Academic Search

Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity,\\u000a which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique\\u000a are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative\\u000a to biological grafts. The initial enthusiasm

Claudio Legnani; Alberto Ventura; Clara Terzaghi; Enrico Borgo; Walter Albisetti

2010-01-01

182

A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players  

Microsoft Academic Search

Background: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large.Hypothesis: A simple on-field alternative warm-up program can reduce noncontact ACL injuries.Study Design: Randomized controlled trial (clustered); Level of evidence, 1.Methods: Participating National Collegiate Athletic Association Division I women's soccer teams were

Julie Gilchrist; Bert R. Mandelbaum; Heidi Melancon; George W. Ryan; Holly J. Silvers; Letha Y. Griffin; Diane S. Watanabe; Randall W. Dick; Jiri Dvorak

2008-01-01

183

Effects of anterior cruciate ligament reconstruction on in vivo, dynamic knee function.  

PubMed

The purposes of this article are to discuss key factors for assessing joint function, to present some recent findings, and to address the future directions for evaluating the function of the anterior cruciate ligament-injured/reconstructed knees. Well-designed studies, using state-of-the art tools to assess knee kinematics under in vivo, dynamic, high-loading conditions, are necessary to evaluate the relative performance of different procedures for restoring normal joint motion. PMID:23177461

Tashman, Scott; Araki, Daisuke

2013-01-01

184

Anterior Cruciate Ligament Revision ReconstructionResults Using a Quadriceps Tendon–Patellar Bone Autograft  

Microsoft Academic Search

Background: The quadriceps tendon is a viable graft source for revision anterior cruciate ligament reconstruction.Purpose: To determine the functional results and graft failure rates in knees in which the patellar tendon had been previously harvested or was unavailable, expanded tunnels precluded the use of a semitendinosus-gracilis graft, or patients requested autogenous tissues instead of allografts for revision reconstruction.Study Design: Case

Frank R. Noyes; Sue D. Barber-Westin

2006-01-01

185

Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers  

Microsoft Academic Search

Rotational stability of the knee has been traditionally difficult to quantify, limiting the ability of the orthopedic community\\u000a to determine the potential role of rotational laxity in the etiology of anterior cruciate ligament (ACL) injuries. The purposes\\u000a of this multicenter cohort study were to evaluate the reliability of a robotic axial rotation measurement system, determine\\u000a whether the uninjured knees of

T. P. Branch; J. E. Browne; J. D. Campbell; R. Siebold; H. I. Freedberg; E. A. Arendt; F. Lavoie; P. Neyret; Cale A. Jacobs

2010-01-01

186

Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation Progression  

PubMed Central

SYNOPSIS The management of patients after anterior cruciate ligament reconstruction should be evidence based. Since our original published guidelines in 1996, successful outcomes have been consistently achieved with the rehabilitation principles of early weight bearing, using a combination of weight-bearing and non–weight-bearing exercise focused on quadriceps and lower extremity strength, and meeting specific objective requirements for return to activity. As rehabilitative evidence and surgical technology and procedures have progressed, the original guidelines should be revisited to ensure that the most up-to-date evidence is guiding rehabilitative care. Emerging evidence on rehabilitative interventions and advancements in concomitant surgeries, including those addressing chondral and meniscal injuries, continues to grow and greatly affect the rehabilitative care of patients with anterior cruciate ligament reconstruction. The aim of this article is to update previously published rehabilitation guidelines, using the most recent research to reflect the most current evidence for management of patients after anterior cruciate ligament reconstruction. The focus will be on current concepts in rehabilitation interventions and modifications needed for concomitant surgery and pathology.

ADAMS, DOUGLAS; LOGERSTEDT, DAVID; HUNTER-GIORDANO, AIRELLE; AXE, MICHAEL J.; SNYDER-MACKLER, LYNN

2013-01-01

187

Anterior cruciate ligament injury and bucket handle tear of the medial meniscus.  

PubMed

The patient was a 27-year-old man with an acute onset of right knee pain, subsequent to a twisting injury that occurred while playing soccer earlier in the day. He was evaluated via direct-access physical therapy 5 hours after the injury. He did not report giving way and locking, but did report feeling a "pop" upon injury. Based on the patient's history and physical examination findings, the therapist was concerned about the possibility of anterior cruciate ligament disruption and medial meniscus tear. The physical therapist ordered conventional radiographs to rule out bony pathology and magnetic resonance imaging of the right knee to assess for internal derangement. The conventional radiographs of the knee were interpreted as normal, while the radiologist's report from the magnetic resonance imaging was significant for an anterior cruciate ligament tear and bucket handle tear of the medial meniscus. The patient was referred to an orthopaedic surgeon and subsequently underwent surgical reconstruction of the anterior cruciate ligament. PMID:19801818

Ballas, Elissa R; Stillman, Charles A

2009-10-01

188

Knee shape might predict clinical outcome after an anterior cruciate ligament rupture.  

PubMed

We have investigated whether shape of the knee can predict the clinical outcome of patients after an anterior cruciate ligament rupture. We used statistical shape modelling to measure the shape of the knee joint of 182 prospectively followed patients on lateral and Rosenberg view radiographs of the knee after a rupture of the anterior cruciate ligament. Subsequently, we associated knee shape with the International Knee Documentation Committee subjective score at two years follow-up. The mean age of patients was 31 years (21 to 51), the majority were male (n = 121) and treated operatively (n = 135). We found two modes (shape variations) that were significantly associated with the subjective score at two years: one for the operatively treated group (p = 0.002) and one for the non-operatively treated group (p = 0.003). Operatively treated patients who had higher subjective scores had a smaller intercondylar notch and a smaller width of the intercondylar eminence. Non-operatively treated patients who scored higher on the subjective score had a more pyramidal intercondylar notch as opposed to one that was more dome-shaped. We conclude that the shape of the femoral notch and the intercondylar eminence is predictive of clinical outcome two years after a rupture of the anterior cruciate ligament. Cite this article: Bone Joint J 2014;96-B:737-42. PMID:24891572

Eggerding, V; van Kuijk, K S R; van Meer, B L; Bierma-Zeinstra, S M A; van Arkel, E R A; Reijman, M; Waarsing, J H; Meuffels, D E

2014-06-01

189

Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female AthletesA Prospective Study  

Microsoft Academic Search

Background: Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.Hypothesis: Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk.Study Design: Cohort study; Level of evidence, 2.Methods: There were 205 female athletes

Timothy E. Hewett; Gregory D. Myer; Kevin R. Ford; Robert S. Heidt; Angelo J. Colosimo; Scott G. McLean; Antonie J. van den Bogert; Mark V. Paterno; Paul Succop

2005-01-01

190

The Strain Behavior of the Anterior Cruciate Ligament During Squatting and Active Flexion-ExtensionA Comparison of an Open and a Closed Kinetic Chain Exercise  

Microsoft Academic Search

The effects of weightbearing (closed kinetic chain) and nonweightbearing (open kinetic chain) exercises on the biomechanical behavior of an injured anterior cru ciate ligament or a healing anterior cruciate ligament graft are unknown. To understand the effects of these exercises on the healing graft, we measured the strain behavior of the normal anterior cruciate ligament in human subjects while they

Bruce D. Beynnon; Robert J. Johnson; Braden C. Fleming; Charles J. Stankewich; Per A. Renström; Claude E. Nichols

1997-01-01

191

Arthroscopic treatment of sports-related anterior osteophytes in the ankle.  

PubMed

Osteophytes on the anterior aspect of the tibia and anterior talus are common in athletes such as dancers, runners, and high jumpers who impact with quick and forceful dorsiflexion to this area. This pathology is often confirmed easily on lateral x-ray films. Excision, debridement, and/or abrasion arthroplasty can be performed arthroscopically to remove osteophytic bone. The joint space is easily approached and managed using small joint or even regular-sized arthroscopic instruments. Care is taken to reshape the anterior tibia and/or talus to its original contour, thus avoiding impingement of the joint space and scuffing of adjacent articular cartilage. Proper abrasion depths and punch lesions may be needed to expose bleeding capillary bone. This allows a regeneration of a fibrocartilage covering that not only decreases pain but also permits a return to functional and athletic activities. Postoperative treatment, including physical therapy, is described. Three case studies are presented that adequately demonstrate this problem, along with the corrective measures taken. Each case concludes with a brief summary of follow-up. PMID:3147229

Hawkins, R B

1988-10-01

192

Analysis of the functional results of arthroscopic Bankart repair in posttraumatic recurrent anterior dislocations of shoulder  

PubMed Central

Background: The Bankart lesion represents the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to shoulder instability. We report the clinical outcome of arthroscopic repair of Bankart lesion in 50 patients. Materials and Methods: Sixty five patients with posttraumatic anterior dislocation of shoulder were treated by arthroscopic repair from Jan 2005 to Nov 2008. Fifty patients, with an average age of 26.83 years (range 18-45 years), were reviewed in the study. The average followup period was 27 months (range 24-36 months). University of California Los Angeles shoulder rating scale was used to determine the outcome after surgery. The recurrence rates, range of motion, as well as postoperative function and return to sporting activities were evaluated. Results: Thirty six patients (72.0%) had excellent results, whereas seven patients (14.0%) had good results. The mean pre- and postoperative range of external rotation was 80.38° and 75.18°, respectively. Eighty-six percent patients had stability compared with the normal sided shoulder and were able to return to sports. There were no cases of redislocation observed in this study; however, three cases had mild laxity of the joint. Conclusion: Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates.

Mishra, Amit; Sharma, Pulak; Chaudhary, Deepak

2012-01-01

193

Changes in dynamic medial tibiofemoral contact mechanics and kinematics after injury of the anterior cruciate ligament: A cadaveric model  

PubMed Central

The effects of tears of the anterior cruciate ligament on knee kinematics and contact mechanics during dynamic everyday activities, such as gait, remains unclear. The objective of this study was to characterize anterior cruciate ligament–deficient knee contact mechanics and kinematics during simulated gait. Nine human cadaveric knees were each augmented with a sensor capable of measuring dynamic normal contact stresses on the tibial plateau, mounted on a load-controlled simulator, and subjected to physiological, multidirectional, dynamic loads to mimic gait. Using a mixed model with random knee identifiers, confidence intervals were constructed for contact stress before and after anterior cruciate ligament transection at two points in the gait cycle at which axial force peaked (14% and 45% of the gait cycle). Kinematic and contact mechanics changes after anterior cruciate ligament transection were highly variable across knees. Nonetheless, a statistically significant increase in contact stress in the posterior–central aspect of the medial tibial plateau at 45% of the gait cycle was identified, the location of which corresponds to the location of degenerative changes that are frequently found in patients with chronic anterior cruciate ligament injury. The variability in the contact stress in other regions of the medial plateau at 45% of the gait cycle was partly explained by the variations in osseous geometry across the nine knees tested. At 14% of gait, there was no significant change in peak contact stress after anterior cruciate ligament transection in any of the four quadrants, and none of the possible explanatory variables showed statistical significance. Understanding the variable effect of anterior cruciate ligament injury on contact mechanics based on geometric differences in osseous anatomy is of paramount clinical importance and may be invaluable to select the best reconstruction techniques and counsel patients on their individual risk of subsequent chondral degeneration.

Bedi, Asheesh; Chen, Tony; Santner, Thomas J; El-Amin, Saadiq; Kelly, Natalie H; Warren, Russell F; Maher, Suzanne A

2014-01-01

194

Changes in dynamic medial tibiofemoral contact mechanics and kinematics after injury of the anterior cruciate ligament: a cadaveric model.  

PubMed

The effects of tears of the anterior cruciate ligament on knee kinematics and contact mechanics during dynamic everyday activities, such as gait, remains unclear. The objective of this study was to characterize anterior cruciate ligament-deficient knee contact mechanics and kinematics during simulated gait. Nine human cadaveric knees were each augmented with a sensor capable of measuring dynamic normal contact stresses on the tibial plateau, mounted on a load-controlled simulator, and subjected to physiological, multidirectional, dynamic loads to mimic gait. Using a mixed model with random knee identifiers, confidence intervals were constructed for contact stress before and after anterior cruciate ligament transection at two points in the gait cycle at which axial force peaked (14% and 45% of the gait cycle). Kinematic and contact mechanics changes after anterior cruciate ligament transection were highly variable across knees. Nonetheless, a statistically significant increase in contact stress in the posterior-central aspect of the medial tibial plateau at 45% of the gait cycle was identified, the location of which corresponds to the location of degenerative changes that are frequently found in patients with chronic anterior cruciate ligament injury. The variability in the contact stress in other regions of the medial plateau at 45% of the gait cycle was partly explained by the variations in osseous geometry across the nine knees tested. At 14% of gait, there was no significant change in peak contact stress after anterior cruciate ligament transection in any of the four quadrants, and none of the possible explanatory variables showed statistical significance. Understanding the variable effect of anterior cruciate ligament injury on contact mechanics based on geometric differences in osseous anatomy is of paramount clinical importance and may be invaluable to select the best reconstruction techniques and counsel patients on their individual risk of subsequent chondral degeneration. PMID:23804954

Bedi, Asheesh; Chen, Tony; Santner, Thomas J; El-Amin, Saadiq; Kelly, Natalie H; Warren, Russell F; Maher, Suzanne A

2013-09-01

195

A novel technique of graft passage in arthroscopically assisted posterior cruciate ligament reconstruction.  

PubMed

Graft passage for cruciate reconstruction can be troublesome. Specific to the posterior cruciate ligament, difficulties can arise after tunnel preparation when trying to retrieve the graft at the back of the knee, because of the angles involved. We recommend directing a cable passer through the notch toward the tibial tunnel. Once engaged, a cerclage wire can be passed antegrade into the tunnel. Pituitary forceps can be passed to deliver the wire. The wire is looped around the pull-through suture attached to the graft and is pulled into the notch. This can then be retrieved during femoral tunnel preparation before locking. This technique can be made easier via a mini-medial arthrotomy or careful digital palpation via any posterior incisions used in the acute setting to address other injuries. To remain inside the joint capsule, we advocate the use of image intensification. The extent of soft-tissue dissection and amount of surgical time can be reduced by use of this method, and it should be added to the armamentarium of surgical procedures in existence for graft passage in posterior cruciate ligament reconstruction. PMID:17681218

Miller, David; Roach, Richard

2007-08-01

196

Long term results of arthroscopic bankart repair for traumatic anterior shoulder instability  

PubMed Central

Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2 year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2004 - 2008). Each patient was followed-up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a Pre and Post Operative Mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.

2011-01-01

197

Estrogen Affects the Cellular Metabolism of the Anterior Cruciate LigamentA Potential Explanation for Female Athletic Injury  

Microsoft Academic Search

Investigations from this laboratory have established the presence of estrogen receptors in the human an terior cruciate ligament. This study further investigates the effects of 17?-estradiol on the cellular proliferation and collagen synthesis of fibroblasts derived from the rabbit anterior cruciate ligament. Fibroblast prolifera tion and collagen synthesis in response to near log concentrations of 17?-estradiol (at 0.0029, 0.025, 0.25,

Stephen H. Liu; Raad A. Al-Shaikh; Vahé Panossian; Gerald A. M. Finerman

1997-01-01

198

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes  

PubMed Central

Background Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men. Purpose To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury. Study Design Case control study; Level of evidence, 3. Methods From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures. Results A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension >90° (P = .71), side-to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament–injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament–injured status increased 4-fold (95% confidence interval, 1.68–9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament–injured status 5-fold (95% confidence interval, 1.24–18.44). Conclusion The current results indicate that increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. The methods to quantify knee joint laxity in this report may be used in conjunction with measures of neuromuscular control of the knee joint to identify high-risk female athletes with high accuracy. Once high-risk female athletes are identified, they may be targeted to the appropriate interventions to reduce injury risk.

Myer, Gregory D.; Ford, Kevin R.; Paterno, Mark V.; Nick, Todd G.; Hewett, Timothy E.

2012-01-01

199

MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction  

PubMed Central

Background After anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel. Patients and methods In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery. Results At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003). Conclusions Enhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma.

Rupreht, Mitja; Vogrin, Matjaz; Hussein, Mohsen

2013-01-01

200

Repair of peripheral meniscal tears: open versus arthroscopic technique.  

PubMed

Tears in the peripheral vascular zone of 71 menisci in 68 knees were repaired by us from 1978 to 1986. The meniscus repair was done by open arthrotomy in 26 cases and by arthroscopic techniques in 45 cases. We have assessed the relative efficacies of open and arthroscopic repair techniques. The results were compared in knees with and without anterior cruciate laxity. The indications for meniscal repair included unstable peripheral detachments and longitudinal tears of the outer third of the meniscus. Open repair was performed by a posteromedial arthrotomy incision. Arthroscopic repair was done using the double-lumen guide system with a limited posterior incision for retrieval of needles. We have found that the arthroscopic technique is easier to perform than the open repair because some tears are too far inside the rim to lend themselves to open suture. The average follow-up is 4 years, 2 months, with a range of 2-10 years. There have been no neurologic or vascular injuries from either technique. Twenty-five patients have had a repeat arthroscopy. The overall failure rate was 9.8%. The difference between the failure rate of 11% in the open-repair group and 8.8% in the arthroscopic repair group was not statistically significant. The failure rate in anterior cruciate-stable knees was 8% versus a 13% failure in cruciate-deficient knees. We conclude that both open and arthroscopic meniscus repair techniques are safe and effective with few complications in both stable and unstable knees. Anterior cruciate ligament stability is ideal, but it is not mandatory for a successful result. PMID:2009124

Hanks, G A; Gause, T M; Sebastianelli, W J; O'Donnell, C S; Kalenak, A

1991-01-01

201

Comparison of Single- and Double-Bundle Anterior Cruciate Ligament Reconstructions in Restoration of Knee Kinematics and Anterior Cruciate Ligament Forces  

PubMed Central

Background Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies. Purpose To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions. Study Design Controlled laboratory study. Methods Ten human cadaveric knees were tested with a robotic testing system under 4 conditions: intact, ACL deficient, single-bundle reconstructed with a quadrupled hamstring tendon graft, and double-bundle reconstructed with 2 looped hamstring tendon grafts. Knee kinematics and forces of the ACL or ACL graft in each knee were measured under 3 loading conditions: an anterior tibial load of 134 N, a simulated quadriceps muscle load of 400 N, and combined tibial torques (10 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of knee flexion. Results The double-bundle reconstruction restored the anterior and medial laxities closer to the intact knee than the single-bundle reconstruction. However, the internal rotation of the tibia under the simulated quadriceps muscle load was significantly decreased when compared with the intact knee after both reconstructions, more so after double-bundle reconstruction (P < .05). The entire graft force of the double-bundle reconstruction was more similar to that of the intact ACL than that of the single-bundle reconstruction. However, the posterolateral bundle graft in the double-bundle reconstructed knee was overloaded as compared with the intact posterolateral bundle. Conclusion The double-bundle reconstruction can better restore the normal anterior-posterior and medial-lateral laxities than the single-bundle reconstruction can, but an overloading of the posterolateral bundle graft can occur in a double-bundle reconstructed knee. Clinical relevance Both single-bundle and double-bundle techniques cannot restore the rotational laxities and the ACL force distributions of the intact knee.

Seon, Jong Keun; Gadikota, Hemanth R.; Wu, Jia-Lin; Sutton, Karen; Gill, Thomas J.; Li, Guoan

2013-01-01

202

Effect of Muscle Loads and Torque Applied to the Tibia on the Strain Behavior of the Anterior Cruciate Ligament: An In Vitro Investigation  

PubMed Central

Background Very little is known about the effects of applied torque about the long axis of the tibia in combination with muscle loads on anterior cruciate ligament biomechanics. The purpose of this study was to determine the effect of muscle contraction and tibial torques applied about the long axis of the tibia on anterior cruciate ligament strain behavior. Methods Six cadaver knee specimens were used to measure the strain behaviour of the anterior cruciate ligament. Internal and external axial torques were applied to the tibia when the knee was between 30° and 120° of flexion in combination with the conditions of no muscle load, isolated quadriceps load, and simultaneous quadriceps and hamstring loading. Findings The highest anterior cruciate ligament strain values were measured when the muscles were not loaded, when the knee was at 120° of flexion, and when internal tibial torques were applied to the knee. During muscle loading the highest anterior cruciate ligament strain values were measured at 30° of flexion and then the strain values gradually decreased with increase in knee flexion. During co-contraction of the quadriceps and hamstring muscles the anterior cruciate ligament was unstrained or minimally strained at 60°, 90° and 120° of knee flexion. Intepretation This study suggests that quadriceps and hamstring muscle co-contraction has a potential role in reducing the anterior cruciate ligament strain values when the knee is in deep flexion. These results can be used to gain insight into anterior cruciate ligament injury mechanisms and to design rehabilitation regimens.

Fujiya, Hiroto; Kousa, Petteri; Fleming, Braden C; Churchill, David L; Beynnon, Bruce D

2011-01-01

203

Return to Basketball and Soccer After Anterior Cruciate Ligament Reconstruction in Competitive School-Aged Athletes  

PubMed Central

Background: Little is known about the return to sports after anterior cruciate ligament reconstruction and whether sex differences exist regarding the level and timing at which athletes return. Hypotheses: Compared to school-aged girls, boys return to full sports earlier and at a higher frequency after surgery (1). Athletes who return to sports earlier will not have a higher incidence of subsequent injury to either knee after surgery (2). Study Design: Cohort. Methods: The patient population comprised 413 consecutive school-aged athletes who were injured while competing in basketball or soccer. Patients were enrolled prospectively, and activity levels were obtained through follow-up visits, surveys, phone calls, and e-mail. Results: Follow-up was obtained for 402 patients (basketball: 58 boys, 242 girls; soccer: 25 boys, 77 girls). Eighty-seven percent of girls and boys returned to high school basketball after surgery: the mean time to return to full participation in basketball was 5.2 ± 2.1 months for girls and 5.3 ± 2.2 months for boys (P = .92). Similarly, 93% of girls and 80% of boys returned to compete in high school soccer after surgery (P = .13); the mean time to return to full participation in soccer was 5.1 ± 1.9 months for girls and 5.1 ± 2.0 for boys (P = 1.00). About 20% of athletes went on to compete in their sport in college. The time of return to sports was not a statistically significant factor for the incidence of subsequent anterior cruciate ligament injury. Conclusion: Of 402 athletes competing in basketball and soccer, women and men returned at the same rate and same level of sport after surgery. Athletes who returned to sports at earlier times after surgery did not have a higher incidence of subsequent anterior cruciate ligament injury than patients who returned at later times.

Shelbourne, K. Donald; Sullivan, A. Nichole; Bohard, Katie; Gray, Tinker; Urch, Scott E.

2009-01-01

204

Anterior cruciate ligament rupture secondary to a 'heel hook': a dangerous martial arts technique.  

PubMed

The 'heel hook' is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a 'heel hook'. PMID:19629437

Baker, Joseph F; Devitt, Brian M; Moran, Ray

2010-01-01

205

Evaluation of meniscal mechanics and proteoglycan content in a modified anterior cruciate ligament transection model.  

PubMed

Post-traumatic osteoarthritis (PTOA) develops as a result of traumatic loading that causes tears of the soft tissues in the knee. A modified transection model, where the anterior cruciate ligament (ACL) and both menisci were transected, was used on skeletally mature Flemish Giant rabbits. Gross morphological assessments, elastic moduli, and glycosaminoglycan (GAG) coverage of the menisci were determined to quantify the amount of tissue damage 12 weeks post injury. This study is one of the first to monitor meniscal changes after inducing combined meniscal and ACL transections. A decrease in elastic moduli as well as a decrease in GAG coverage was seen. PMID:24749144

Fischenich, Kristine M; Coatney, Garrett A; Haverkamp, John H; Button, Keith D; DeCamp, Charlie; Haut, Roger C; Haut Donahue, Tammy L

2014-07-01

206

Management of intraoperative complications associated with autogenous patellar tendon graft anterior cruciate ligament reconstruction.  

PubMed

With the increasing number of anterior cruciate ligament (ACL) reconstructions being performed each year in the United States, sound surgical technique and preoperative planning are essential to decrease complications. Most intraoperative complications associated with ACL surgery are preventable with adequate planning and a reproducible surgical technique. When an autogenous bone-patellar tendon-bone graft is used for ACL reconstruction, pitfalls may occur at each step during the surgical procedure--preoperative assessment, graft harvest, notch preparation, tunnel preparation, graft passage and fixation, and rehabilitation. An array of options should be available for fixation of a patellar tendon graft, as well as alternative graft sources and graft preparation techniques. PMID:12690863

Cain, E Lyle; Gillogly, Scott D; Andrews, James R

2003-01-01

207

Embolism of the popliteal artery after anterior cruciate ligament reconstruction: a case report and literature review  

PubMed Central

Arterial complications after anterior cruciate ligament reconstruction (ACLR) are rare. We present a case report of a 44-year-old male patient with a subtotal occlusion of the popliteal artery, with sensory loss in the foot, 17 days after ACLR. Embolectomy and anticoagulant therapy led to full recovery of the peripheral arterial circulation. The sensory loss of the foot also fully recovered. To our knowledge, this is the first case report of an embolus of the popliteal artery after ACLR without relation to graft fixation. A literature review on vascular complications after ACLR is presented.

Sala, H. A. G. M.

2007-01-01

208

Popliteal artery pseudoaneurysm after anterior cruciate ligament re-revision using a rigidfix cross pin.  

PubMed

Popliteal artery injury is a very rare complication of anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of popliteal arterial pseudoaneurysm after re-revision of ACL reconstruction using Rigidfix for femoral tunnel fixation. Pseudoaneurysm was detected in knee magnetic resonance imaging, which caused pain, limit of motion, common peroneal nerve palsy, leg swelling and symptoms similar to compartment syndrome. After excision and re-anastomosis of the popliteal artery using a greater saphenous vein graft, all symptoms were resolved within 3 months except for common peroneal nerve palsy. So we report on this case with a review of the literature. PMID:24944979

Lee, Gwang Chul; Kim, Dong Hwi; Park, Sung-Hae

2014-06-01

209

Thermal modification of the lax anterior cruciate ligament using radiofrequency: efficacy or catastrophe?  

PubMed

Alchemists dream of using energy to turn base metal to gold. "Shrinkers" use energy to transform laxity to stability. While alchemists search for the mechanism to achieve their goal, shrinkers have thermal energy (heat) and scientific ground for their pursuit. Without doubt, application of heat to collagen using radiofrequency (RF) results in tissue shrinkage. However, with regard to thermal shrinkage of a lax anterior cruciate ligament (ACL) or ACL graft, indications and techniques, rehabilitation and outcomes require review. Such is the purpose of this article. PMID:15947914

Lubowitz, James H

2005-09-01

210

Popliteal Artery Pseudoaneurysm after Anterior Cruciate Ligament Re-Revision Using a Rigidfix Cross Pin  

PubMed Central

Popliteal artery injury is a very rare complication of anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of popliteal arterial pseudoaneurysm after re-revision of ACL reconstruction using Rigidfix for femoral tunnel fixation. Pseudoaneurysm was detected in knee magnetic resonance imaging, which caused pain, limit of motion, common peroneal nerve palsy, leg swelling and symptoms similar to compartment syndrome. After excision and re-anastomosis of the popliteal artery using a greater saphenous vein graft, all symptoms were resolved within 3 months except for common peroneal nerve palsy. So we report on this case with a review of the literature.

Kim, Dong Hwi; Park, Sung-Hae

2014-01-01

211

A Comparison of Arthroscopically Assisted Single and Double Bundle Tibial Inlay Reconstruction for Isolated Posterior Cruciate Ligament Injury  

PubMed Central

Background This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury. Methods This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively. Results The Lysholm knee scores in groups A and B increased from an average of 43.3 ± 7.04 and 44.7 ± 5.02 preoperatively to 88.1 ± 7.32 and 88.7 ± 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 ± 1.60 mm at 30° of flexion and 9.8 ± 1.70 mm at 90° of flexion were improved to 2.8 ± 1.19 mm and 3.0 ± 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 ± 1.50 mm at 30° of flexion and 10.7 ± 1.60 mm at 90° of flexion improved to 2.7 ± 1.15 mm and 2.6 ± 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups. Conclusions Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury.

Lee, Dong Chul; Park, Chul Hyun; Kim, Won Ho; Jung, Kwang Am

2010-01-01

212

[Arthroscopic capsulo-labral repair and refixation with Mitek anchor in anterior shoulder instability].  

PubMed

From May 1992 to September 1995, 38 patients with recurrent anterior shoulder instability underwent arthroscopic stabilization. The arthroscopic stabilization was performed by capsular shifting and labral refixation using Mitek anchors, based on the Wolf procedure. Immediately after operation active assisted shoulder mobilization was initiated (elevation 60 degrees, external rotation 20 degrees less than contralateral shoulder). After a mean follow-up of 24 months (12-42 months) 30 patients were evaluated by means of the Rowe Score. Excellent and good results were achieved in 90% (n = 27) of patients and 80% had no restriction in sports activities. In 4 of the patients (13%) redislocation occurred. Analysis of the recurrence revealed no adequate trauma in two patients with preoperative multidirectional laxity. One had a trauma and the fourth showed no compliance in the early postoperative period. Compared to the open Bankart operation the described procedure shows a slightly higher rate of redislocations. However, the approach is less invasive and the subscapularis tendon with its proprioception remains intact. PMID:9381773

Speck, M; Hertel, R

1997-01-01

213

Revision anterior cruciate ligament surgery using the over-the-top femoral route.  

PubMed

Primary anterior cruciate ligament (ACL) reconstruction is considered a successful surgical procedure, but the results reported for revision ACL surgery are less satisfactory. The most common cause of technical failure in primary reconstruction is tunnel misplacement, particularly on the femoral side, although an anterior placement of the tibial tunnel may lead to graft impingement and failure. Several technical problems are encountered during revision procedures. We describe a technique for revision ACL surgery using a special jig for preparing the tibial tunnel that references the apex and roof of the intercondylar notch and an over-the-top routing for proximal femoral placement. This combination avoids graft impingement at the tibial tunnel exit and circumvents the problems associated with further femoral tunnel preparation. PMID:15689877

Yiannakopoulos, Christos K; Fules, Peter J; Korres, Dimitrios S; Mowbray, Michael A S

2005-02-01

214

Effects of knee bracing on the sensorimotor function of subjects with anterior cruciate ligament reconstruction.  

PubMed

The sensorimotor performance of the knee joint in 31 subjects who had undergone unilateral anterior cruciate ligament reconstruction at least 5 months previously was tested under three bracing conditions, 1) the DonJoy Legend brace, 2) a mechanical placebo brace, and 3) no brace, in random order. The accuracy of the subjects' ability to reproduce specified knee joint angles was tested as well as the isokinetic performance of their knee muscles at 60 and 180 deg/sec. The results showed that subjects with the brace or placebo brace performed similarly in reproducing the knee joint positions, but both groups performed better than the subjects without a brace. Isokinetic tests revealed no difference among the three groups in extensor and flexor peak torque production at 60 deg/sec or total work done by the extensors and flexors at 60 and 180 deg/sec. These results suggest that knee bracing can improve the static proprioception of the knee joint, but not the muscle contractile function, in subjects with anterior cruciate ligament reconstruction under isokinetic testing conditions. The finding of similar performances for joint angle reproduction in the brace and placebo brace groups suggests that the apparent improvement in proprioception with knee bracing was not due to the mechanical restraining action of the brace. PMID:11573924

Wu, G K; Ng, G Y; Mak, A F

2001-01-01

215

Tissue Engineering of the Anterior Cruciate Ligament Using a Braid-Twist Scaffold Design  

PubMed Central

The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee. The insufficient vascularization of this tissue prevents it from healing completely after extreme tearing or rupture, creating a need for ACL grafts for reconstruction. The limitations of existing grafts have motivated the investigation of tissue engineered ACL grafts. A successful tissue engineered graft must possess mechanical properties similar to the ACL; to date no commercially available synthetic graft has achieved this. To accomplish this goal we have combined the techniques of polymer fiber braiding and twisting to design a novel poly L-lactic acid (PLLA) braid-twist scaffold for ACL tissue engineering. The scaffold is designed to accurately mimic the biomechanical profile and mechanical properties of the ACL. In this study, braid-twist scaffolds were constructed and compared to braided scaffolds and twisted fiber scaffolds. The addition of fiber twisting to the braided scaffold resulted in a significant increase in the ultimate tensile strength, an increase in ultimate strain, and an increase in the length of the toe region in these constructs over scaffolds that were braided. Based on the findings of this study, the braid-twist scaffold studied was found to be a promising construct for tissue engineering of the anterior cruciate ligament.

Freeman, Joseph W.; Woods, Mia D.; Laurencin, Cato T.

2007-01-01

216

Effects of gene?activated matrix on autograft healing of anterior cruciate ligament.  

PubMed

The aim of the present study was to observe the effects of gene?activated matrix (GAM) on autograft healing of the anterior cruciate ligament. Forty?eight rabbits were randomly divided into groups A and B. Rabbits were used to construct models of anterior cruciate ligament reconstruction. In group A, transforming growth factor (TGF)??1 was locally injected into the bone tunnel, while in group B, empty vector was administered. Tendons were removed to observe histology and ultrastructure and to evaluate biomechanics at postoperative months 1, 3 and 6. Optical microscopy revealed increased numbers of fibroblasts and collagen fibers in group A at each time?point compared with B. Electron microscopy identified increased mitosis and abundance of fibroblasts, endoplasmic reticulum and mitochondria in group A at each time?point compared with B. No significant difference was identified in the biomechanical parameters between the 2 groups at postoperative month 1. At postoperative months 3 and 6, maximum force and elastic modulus were greater in group A compared with group B (P<0.0.5). No significant differences in other biochemical parameters were observed at these time?points. The healing ligament graft transfected with TGF??1 by GAM was observed to have improved tissue structure and biomechanical characteristics. The results of the current study may provide a theoretical basis for GAM application in ligament repair. PMID:23229157

Qin, Jian; Hou, Zhi-Qi; Wang, Hui; Wang, Xin-Liang; Liu, Yong-Yi; Gao, Xing-Hua; Lin, Yu-Jin; Huang, Bao-Hua

2013-02-01

217

Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors  

Microsoft Academic Search

To determine the incidence of joint sepsis following anterior cruciate ligament (ACL) reconstruction and the prevailing attitudes toward its treatment, we surveyed the directors of Sports Medicine Fellowship programs about their practices in treating and preventing this complication. Of the 74 surgeons surveyed, 61 (82%) responded. These 61 surgeons performed an average of 98 ACL reconstructions yearly; 31 (51 %)

MJ Matava; TA Evans; RW Wright; RA Shively

1998-01-01

218

Regeneration of the semitendinosus and gracilis tendons following their transection for repair of the anterior cruciate ligament  

Microsoft Academic Search

Apparent regeneration of the tendons of the semiten dinosus and gracilis muscles after their use for anterior cruciate ligament reconstruction was noted during rou tine followup of 225 patients. From this group, four patients were selected for thorough examination, in cluding magnetic resonance imaging, electromyo graphic studies, strength testing, and clinical examina tion. The results demonstrate that these tendons ap

Mervyn J. Cross; Greg Roger; Ples Kujawa; Ian F. Anderson

1992-01-01

219

Anterior Cruciate Ligament Graft FixationInitial Comparison of Patellar Tendon and Semitendinosus Autografts in Young Fresh Cadavers  

Microsoft Academic Search

The initial biomechanical properties of semitendinosus and patellar tendon autografts and their fixation strengths were investigated. Twenty fresh cadaveric knees from donors under 42 years of age were used in the study. After removing all soft tissues other than the anterior cruciate ligament, we determined the ultimate tensile strength (2195 ± 427 N) and stiffness (306 ± 80 N\\/mm) of

Neville J. Rowden; Doron Sher; Greg J. Rogers; Klaus Schindhelm

1997-01-01

220

Biomechanics of patellar tendon autograft for reconstruction of the anterior cruciate ligament in the goat: three-year study.  

PubMed

This study examined the biomechanics of anterior cruciate ligament-patellar tendon autografts for as long as 3 years after surgery. Twenty-seven adult female goats were tested; four served as controls and the others received an autograft to the right knee with each left knee serving as an additional control. The animals with grafts were tested at 0 week (n = 4), 6 weeks (n = 4), 12 weeks (n = 4), 24 weeks (n = 3), 1 year (n = 5), and 3 years (n = 3) after surgery. The anteroposterior laxity of the knee joint, load-relaxation, and structural and material properties of the graft were tested. The anteroposterior laxity was significantly greater than that of the controls for all groups except at 3 years. Load-relaxation was greater than that of the control anterior cruciate ligaments, but in the 1 and 3-year grafts load-relaxation was less than that of the patellar tendons with 5 minutes of sustained loading. Between 12 and 52 weeks, the stiffness and modulus of the grafts increased 3-fold, but the improvement was slow afterward. At 3 years, the strength and stiffness of the grafts were 44 and 49% those of the control ligaments, respectively; the modulus was 37 and 46% that of the control anterior cruciate ligaments and patellar tendons, respectively. The persistent inferior mechanical performance at 3 years suggests that anterior cruciate ligament grafts may never attain normal strength. PMID:7674076

Ng, G Y; Oakes, B W; Deacon, O W; McLean, I D; Lampard, D

1995-07-01

221

Selecting outcome measures in sports medicine: a guide for practitioners using the example of anterior cruciate ligament rehabilitation  

Microsoft Academic Search

Using examples from the field of anterior cruciate ligament rehabilitation, this review provides sports and health practitioners with a comprehensive, user-friendly, guide to selecting outcome measures for use with active populations. A series of questions are presented for consideration when selecting a measure: is the measure appropriate for the intended use? (appropriateness); is the measure acceptable to patients? (acceptability); is

N P Bent; C C Wright; A B Rushton; M E Batt

2009-01-01

222

In Vivo Evaluation of a TriPhasic Composite Scaffold for Anterior Cruciate Ligament-to-Bone Integration  

Microsoft Academic Search

The widespread clinical implementation of hamstring tendon (HT) autografts for anterior cruciate ligament (ACL) reconstruction is currently limited by the unpredictable integration of the graft with subchondral bone and a lack of devices that are capable of promoting biological fixation of HT grafts to bone. The site of HT graft fixation within the bone tunnel has been identified as the

Jeffrey P. Spalazzi; Elias Dagher; Stephen B. Doty; X. Edward Guo; Scott A. Rodeo; Helen H. Lu

2006-01-01

223

High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury  

Microsoft Academic Search

Objective. To determine the prevalence of radio- graphic knee osteoarthritis (OA) as well as knee-related symptoms and functional limitations in female soccer players 12 years after an anterior cruciate ligament (ACL) injury. Methods. Female soccer players who sustained an ACL injury 12 years earlier were examined with stan- dardized weight-bearing knee radiography and 2 self- administered patient questionnaires, the Knee

L. S. Lohmander; M. Englund; H. Roos

2004-01-01

224

A Randomised Controlled Trial of Proprioceptive and Balance Training after Surgical Reconstruction of the Anterior Cruciate Ligament  

Microsoft Academic Search

A randomised controlled trial (29 participants) was used to compare a 6-week proprioceptive and balance exercise program with a 6-week strengthening program in the early phases of rehabilitation after anterior cruciate ligament (ACL) reconstruction. Measurements of functional activity were taken by a blinded assessor before the intervention and at the end of the 6 weeks. Results demonstrated that there were

R. L. Cooper; N. F. Taylor; J. A. Feller

2005-01-01

225

Visualization of Torn Anterior Cruciate Ligament Using 3-Dimensional Computed Tomography  

PubMed Central

Recently, a remnant-preserving anterior cruciate ligament (ACL) reconstruction technique has been developed. However, the preoperative condition of remnant ACL is occasionally difficult to evaluate by magnetic resonance imaging. The purpose of this study is to evaluate the accuracy of pre-operative visualization of remnant ACL using three-dimensional computed tomography (3D-CT). The remnant ACL in 25 patients was examined by 3DCT before ACL reconstruction surgery. Findings on 3D-CT images and arthroscopy were compared. The 3D-CT images were classified into 4 groups: Group A, remnant fibers attached to the posterior cruciate ligament (PCL); Group B, those located between the PCL and the lateral wall; Group C, those attached to the lateral wall; and Group D, no identifiable remnant fibers on the tibial side. These groups were made up of 4, 3, 9 and 9 patients, respectively. Findings on 3D-CT images were identical to those during arthroscopy in 20 of 25 cases (80%). Remnant ACL can be accurately evaluated using 3D-CT in 80% of cases of torn ACL. This novel method is a useful technique for pre-operative assessment of remnant ACL.

Uozumi, Hiroaki; Aizawa, Toshimi; Sugita, Takehiko; Kunii, Tomonori; Abe, Shun; Itoi, Eiji

2013-01-01

226

Arthroscopic absorbable suture fixation for tibial spine fractures.  

PubMed

The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware. PMID:24749022

Verdano, Michele Arcangelo; Pellegrini, Andrea; Lunini, Enricomaria; Tonino, Pietro; Ceccarelli, Francesco

2014-02-01

227

Arthroscopic Absorbable Suture Fixation for Tibial Spine Fractures  

PubMed Central

The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware.

Verdano, Michele Arcangelo; Pellegrini, Andrea; Lunini, Enricomaria; Tonino, Pietro; Ceccarelli, Francesco

2013-01-01

228

Role of the medial structures in the intact and anterior cruciate ligament-deficient knee. Limits of motion in the human knee.  

PubMed

We measured motion limits in human cadaveric knees before and after sectioning the anterior cruciate ligament and the medial structures. Sectioning the medial collateral ligament in an anterior cruciate ligament-deficient knee increased the anterior translation limit at 90 degrees of flexion but not at 30 degrees of flexion. The tibia displaced straight anteriorly without exhibiting the coupled internal rotation that occurred in intact and anterior cruciate ligament-deficient knees. A lateral 15 N-m abduction moment produced a coupled external rotation in the medial collateral ligament-deficient knee. This was in marked contrast to intact, anterior cruciate ligament-deficient, or combined medial collateral ligament and anterior cruciate ligament-deficient knees, in which an abduction moment produced a coupled internal rotation. Sectioning only the medial collateral ligament caused a small but significant increase in the abduction rotation limit, whereas larger increases in the abduction rotation limit occurred when the posterior oblique ligament and posterior medial capsule were cut in addition to the medial collateral ligament. Cutting the medial collateral ligament increased the external rotation limit. The increase was independent of whether the anterior cruciate ligament was intact or sectioned. Subsequent cutting of the posterior oblique ligament and posterior medial capsule further increased the external rotation limit. PMID:8037282

Haimes, J L; Wroble, R R; Grood, E S; Noyes, F R

1994-01-01

229

Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft and press-fit fixation using an anteromedial portal technique  

PubMed Central

Background This article describes an arthroscopic anterior cruciate ligament (ACL) reconstruction technique with a quadriceps tendon autograft using an anteromedial portal technique. Methods A 5?cm quadriceps tendon graft is harvested with an adjacent 2?cm bone block. The femoral tunnel is created through a low anteromedial portal in its anatomical position. The tibial tunnel is created with a hollow burr, thus acquiring a free cylindrical bone block. The graft is then passed through the tibial tunnel and the bone block, customized at its tip, is tapped into the femoral tunnel through the anteromedial portal to provide press-fit fixation. The graft is tensioned distally and sutures are tied over a bone bridge at the distal end of the tibial tunnel. From the cylindrical bone block harvested from the tibia the proximal end is customized and gently tapped next to the graft tissue into the tibial tunnel to assure press fitting of the graft in the tibial tunnel. The distal part of the tibial tunnel is filled up with the remaining bone. All patients were observed in a prospective fashion with subjective and objective evaluation after 6?weeks, 6 and 12?months. Results Thirty patients have been evaluated at a 12?months follow-up. The technique achieved in 96.7% normal or nearly normal results for the objective IKDC. The mean subjective IKDC score was 86.1 ± 15.8. In 96.7% the Tegner score was the same as before injury or decreased one category. A negative or 1+ Lachman test was achieved in all cases. Pivot-shift test was negative or (+) glide in 86.7%. The mean side-to-side difference elevated by instrumental laxity measurement was 1.6 ± 1.1?mm. Full ROM has been achieved in 92.3%. The mean single one-leg-hop index was 91.9 ± 8.0 at the follow-up. Conclusions Potential advantages include minimum bone loss specifically on the femoral side and graft fixation without implants.

2012-01-01

230

Saphenous neuropathy secondary to extraneural ganglion cyst 15 years after reconstruction of the anterior cruciate ligament.  

PubMed

This case report describes a 43-year-old woman with a previous anterior cruciate ligament reconstruction and medial meniscectomy who presented with right knee dysesthesias radiating into her medial ankle with associated allodynia. An extensive work-up was pursued, without a definitive diagnosis found or improvement in the patient's symptoms. Eventually, she was referred to Pain Medicine for an ultrasound-guided saphenous nerve (SN) block, where a scan before the injection revealed a large cyst anteromedial to the sartorius in the expected location of the SN. Magnetic resonance imaging and surgical pathology confirmed a juxta-articular ganglion cyst compressing the main SN, just above the take-off of the infrapatellar branch. The cyst was successfully resected, with improvement noted in the patient's neuropathic symptoms postoperatively. Saphenous neuropathy is a rare condition, and to our knowledge this case is the first reported of saphenous neuropathy caused by a knee joint capsule-derived ganglion cyst. PMID:24507555

Sole, Joshua S; Pingree, Matthew J; Spinner, Robert J; Murthy, Naveen S; Sellon, Jacob L

2014-05-01

231

Three-Dimensional Engineered Bone-Ligament-Bone Constructs for Anterior Cruciate Ligament Replacement  

PubMed Central

The anterior cruciate ligament (ACL), a major stabilizer of the knee, is commonly injured. Because of its intrinsic poor healing ability, a torn ACL is usually reconstructed by a graft. We developed a multi-phasic, or bone–ligament–bone, tissue-engineered construct for ACL grafts using bone marrow stromal cells and sheep as a model system. After 6 months in vivo, the constructs increased in cross section and exhibited a well-organized microstructure, native bone integration, a functional enthesis, vascularization, innervation, increased collagen content, and structural alignment. The constructs increased in stiffness to 52% of the tangent modulus and 95% of the geometric stiffness of native ACL. The viscoelastic response of the explants was virtually indistinguishable from that of adult ACL. These results suggest that our constructs after implantation can obtain physiologically relevant structural and functional characteristics comparable to those of adult ACL. They present a viable option for ACL replacement.

Ma, Jinjin; Smietana, Michael J.; Kostrominova, Tatiana Y.; Wojtys, Edward M.; Larkin, Lisa M.

2012-01-01

232

A review of recent perspectives on biomechanical risk factors associated with anterior cruciate ligament injury.  

PubMed

There is considerable evidence to support a number of biomechanical risk factors associated with non-contact anterior cruciate ligament (ACL) injury. This paper aims to review these biomechanical risk factors and highlight future directions relating to them. Current perspectives investigating trunk position and relationships between strength, muscle activity and biomechanics during landing/cutting highlight the importance of increasing hamstring muscle force during dynamic movements through altering strength, muscle activity, muscle length and contraction velocity. In particular, increased trunk flexion during landing/cutting and greater hamstring strength are likely to increase hamstring muscle force during landing and cutting which have been associated with reduced ACL injury risk. Decision making has also been shown to influence landing biomechanics and should be considered when designing tasks to assess landing/cutting biomechanics. Coaches should therefore promote hamstring strength training and active trunk flexion during landing and cutting in an attempt to reduce ACL injury risk. PMID:24650339

Hughes, Gerwyn

2014-01-01

233

Anterior cruciate ligament injury: identification of risk factors and prevention strategies.  

PubMed

Injury to the anterior cruciate ligament (ACL) is common and affects young individuals, particularly girls, who are active in sports that involve jumping, pivoting, as well as change of direction. ACL injury is associated with potential long-term complications including reduction in activity levels and osteoarthritis. Multiple intrinsic and extrinsic risk factors have been identified, which include anatomic variations, neuromuscular deficits, biomechanical abnormalities, playing environment, and hormonal status. Multicomponent prevention programs have been shown to be effective in reducing the incidence of this injury in both girls and boys. Programs should include a combination of strengthening, stretching, aerobic conditioning, plyometrics, proprioceptive and balance training, as well as education and feedback regarding body mechanics and proper landing pattern. Preventive programs should be implemented at least 6 wk prior to competition, followed by a maintenance program during the season. PMID:24819011

Acevedo, Rafael J; Rivera-Vega, Alexandra; Miranda, Gerardo; Micheo, William

2014-01-01

234

Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report  

PubMed Central

We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL) deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.

Garcia-German, Diego; Menendez, Pablo; de la Cuadra, Pablo; Rodriguez-Arozena, Ricardo

2013-01-01

235

Development of a silk and collagen fiber scaffold for anterior cruciate ligament reconstruction.  

PubMed

The objective of this study was to determine a silk-collagen fiber ratio for an anterior cruciate ligament (ACL) reconstruction composite scaffold device. Composite fiber scaffolds with silk volumes ?14 % and collagen volume <86 % demonstrated comparable or greater initial ultimate tensile stress relative to the human ACL. Silk scaffolds implanted subcutaneously and intraarticularly in rabbits demonstrated an 84 and 92 % reduction in strength with a 26 and 22 % reduction in volume after 8 weeks, respectively. The mechanical degradation findings of this preliminary study suggest that a composite scaffold with an initial UTS value of at least 129 MPa, or roughly a 48:52 silk to collagen volume ratio meets the minimal mechanical requirements necessary to proceed to a functional ACL reconstruction study in vivo. PMID:23053810

Panas-Perez, Eleni; Gatt, Charles J; Dunn, Michael G

2013-01-01

236

ANTERIOR CRUCIATE LIGAMENT INJURY DIAGNOSIS AND MANAGEMENT IN A PEDIATRIC PATIENT: A CASE REPORT  

PubMed Central

The management of the skeletally immature athlete sustaining injury to the anterior cruciate ligament and other knee structures provides multiple challenges for both the treating clinicians and parents of the injured child. The diagnostic process and subsequent decision making present additional complexities because of the developmental anatomy and the potential for disturbance of normal growth patterns by some surgical interventions. In the following case report, the course to appropriate management of a young athlete is detailed, including the contributions of imaging results. The reconstructive options available to orthopedic surgeons and the patient's post?operative progression are also briefly discussed. Rehabilitation practitioners require an understanding of the unique issues present when providing care for pediatric and adolescent athletes with knee injuries in order to assist in optimal decision making in the phases during which they are involved. Level of Evidence: 5 (Single Case Report)

Duby, Cherie

2012-01-01

237

Anterior Cruciate Ligament Tear in an Athlete: Does Increased Heel Loading Contribute to ACL Rupture?  

PubMed Central

Rupture to the anterior cruciate ligament is a common athletic injury in American football. The lower extremity biomechanics related to increased ACL injury risk are not completely understood. However, foot landing has been purported to be a significant contributing factor to the ACL injury mechanism. In this case report, information is presented on an athlete previously tested for in-shoe loading patterns on artificial turf and subsequently went on to non-contact ACL rupture on the same surface. This case report describes the specific findings in a study participant who suffered an ACL rupture after testing and suggests that flatfoot tendency in running and cutting maneuvers might lead to an increased risk of ACL injury.

Burkhart, Bradd; Ford, Kevin R.; Heidt, Robert S.; Hewett, Timothy E.

2008-01-01

238

ANTERIOR CRUCIATE LIGAMENT TEAR IN AN ATHLETE: DOES INCREASED HEEL LOADING CONTRIBUTE TO ACL RUPTURE?  

PubMed

Rupture to the anterior cruciate ligament is a common athletic injury in American football. The lower extremity biomechanics related to increased ACL injury risk are not completely understood. However, foot landing has been purported to be a significant contributing factor to the ACL injury mechanism. In this case report, information is presented on an athlete previously tested for in-shoe loading patterns on artificial turf and subsequently went on to non-contact ACL rupture on the same surface. This case report describes the specific findings in a study participant who suffered an ACL rupture after testing and suggests that flatfoot tendency in running and cutting maneuvers might lead to an increased risk of ACL injury. PMID:20333261

Burkhart, Bradd; Ford, Kevin R; Myer, Gregory D; Heidt, Robert S; Hewett, Timothy E

2008-08-01

239

Synovial osteochondroma originating from the synovium of the anterior cruciate ligament.  

PubMed

Primary synovial osteochondromatosis is a rarely seen disorder of the synovium in any joints. Among reported cases of knee osteochondromatosis, those originating from the anterior cruciate ligament (ACL) are very rare. We report an unusual case of primary synovial osteochondromatosis. A 27-year-old woman complained of a restricted range of right-knee motion and pain when walking. With locking symptoms similar to those associated with a meniscus bucket handle tear. Although plain radiograph and MRI showed normal appearance, diagnostic arthroscopy revealed the curious appearance of a huge mass seated on ACL. In addition, the sign of proliferation of synovium and cartilaginous tissues were apparent. The ACL mass has been removed while preserving the ACL fibres. Histological examination confirmed a diagnosis of osteochondromatosis. To the best of our knowledge, this is the first report to describe synovial osteochondromatosis originating from ACL fibres and has been resected while preserving the ACL. PMID:23345533

Alaqeel, Motaz Abdulrhuman; Al-Ahaideb, Abdulaziz

2013-01-01

240

Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells  

SciTech Connect

Highlights: {yields} CCN2/CTGF localizes to the ligament-to-bone interface, but is not to the midsubstance region of human anterior cruciate ligament (ACL). {yields} Mechanical stretch induces higher increase of CCN2/CTGF gene expression and protein secretion in ACL interface cells compared with ACL midsubstance cells. {yields} CCN2/CTGF treatment stimulates the proliferation of ACL interface cells. -- Abstract: Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates {alpha}1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.

Miyake, Yoshiaki [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan) [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Furumatsu, Takayuki, E-mail: matino@md.okayama-u.ac.jp [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Kubota, Satoshi; Kawata, Kazumi [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Ozaki, Toshifumi [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Orthopaedic Surgery, Science of Functional Recovery and Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan); Takigawa, Masaharu [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)] [Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama (Japan)

2011-06-03

241

In vivo anterior cruciate ligament elongation in response to axial tibial loads  

PubMed Central

Background The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated the relative elongation of the ACL when the knee is subject to no load (<10 N) and then to full body weight (axial tibial load) at various flexion angles using a combined dual fluoroscopic and magnetic resonance imaging (MRI) technique. Methods Nine healthy subjects were scanned with MRI and imaged when one knee was subject to no load and then to full body weight using a dual fluoroscopic system (0°–45° flexion angles). The ACL was analyzed using three models: a single central bundle; an anteromedial and posterolateral (double functional) bundle; and multiple (eight) surface fiber bundles. Results The anteromedial bundle had a peak relative elongation of 4.4% ± 3.4% at 30° and that of the posterolateral bundle was 5.9% ± 3.4% at 15°. The ACL surface fiber bundles at the posterior portion of the ACL were shorter in length than those at the anterior portion. However, the peak relative elongation of one posterolateral fiber bundle reached more than 13% whereas one anteromedial fiber bundle reached a peak relative elongation of only about 3% at 30° of flexion by increasing the axial tibial load from no load to full body weight. Conclusions The data quantitatively demonstrated that under external loading the ACL experiences nonhomogeneous elongation, with the posterior fiber bundles stretching more than the anterior fiber bundles.

Hosseini, Ali; Gill, Thomas J.; Li, Guoan

2013-01-01

242

Resorbable screws versus pins for optimal transplant fixation (SPOT) in anterior cruciate ligament replacement with autologous hamstring grafts: rationale and design of a randomized, controlled, patient and investigator blinded trial [ISRCTN17384369  

PubMed Central

Background Ruptures of the anterior cruciate ligament (ACL) are common injuries to the knee joint. Arthroscopic ACL replacement by autologous tendon grafts has established itself as a standard of care. Data from both experimental and observational studies suggest that surgical reconstruction does not fully restore knee stability. Persisting anterior laxity may lead to recurrent episodes of giving-way and cartilage damage. This might at least in part depend on the method of graft fixation in the bony tunnels. Whereas resorbable screws are easy to handle, pins may better preserve graft tension. The objective of this study is to determine whether pinning of ACL grafts reduces residual anterior laxity six months after surgery as compared to screw fixation. Design/ Methods SPOT is a randomised, controlled, patient and investigator blinded trial conducted at a single academic institution. Eligible patients are scheduled to arthroscopic ACL repair with triple-stranded hamstring grafts, conducted by a single, experienced surgeon. Intraoperatively, subjects willing to engage in this study will be randomised to transplant tethering with either resorbable screws or resorbable pins. No other changes apply to locally established treatment protocols. Patients and clinical investigators will remain blinded to the assigned fixation method until the six-month follow-up examination. The primary outcome is the side-to-side (repaired to healthy knee) difference in anterior translation as measured by the KT-1000 arthrometer at a defined load (89 N) six months after surgery. A sample size of 54 patients will yield a power of 80% to detect a difference of 1.0 mm ± standard deviation 1.2 mm at a two-sided alpha of 5% with a t-test for independent samples. Secondary outcomes (generic and disease-specific measures of quality of life, magnetic resonance imaging morphology of transplants and devices) will be handled in an exploratory fashion. Conclusion SPOT aims at showing a reduction in anterior knee laxity after fixing ACL grafts by pins compared to screws.

Stengel, Dirk; Matthes, Gerrit; Seifert, Julia; Tober, Volker; Mutze, Sven; Rademacher, Grit; Ekkernkamp, Axel; Bauwens, Kai; Wich, Michael; Casper, Dirk

2005-01-01

243

Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes2Year Follow-up  

Microsoft Academic Search

Background: Among female athletes it has not been established whether a neuromuscular and proprioceptive sports-specific training program will consistently reduce the incidence of anterior cruciate ligament injuries.Purpose: To determine whether a neuromuscular and proprioceptive performance program was effective in decreasing the incidence of anterior cruciate ligament injury within a select population of competitive female youth soccer players.Study Design: Cohort study;

Bert R. Mandelbaum; Holly J. Silvers; Diane S. Watanabe; John F. Knarr; Stephen D. Thomas; Letha Y. Griffin; Donald T. Kirkendall; William Garrett

2005-01-01

244

Association between Femoral Anteversion and Lower Extremity Posture upon Single-leg Landing: Implications for Anterior Cruciate Ligament Injury  

PubMed Central

[Purpose] Increased femoral anteversion may occur with hip internal rotation and valgus knee alignment upon landing and is considered a risk factor for anterior cruciate ligament injury. We examined the relationship between femoral anteversion and joint motion and muscle activity of the lower extremity in terms of the risk factors for anterior cruciate ligament injury. [Subjects] Sixteen healthy females were divided on the basis of femoral anteversion into low and high groups. [Methods] Femoral anteversion was assessed using Craig's test. We performed kinematic analysis and measured the electromyography activity of the lower extremity upon left single-leg landing. [Results] The high group had a significantly lower hip flexion angle and higher knee flexion and valgus angles than the low group. The rectus femoris showed significantly greater electromyography activities in the high group than in the low group. [Conclusion] These results suggest that increased femoral anteversion results in lower hip flexion angle, higher knee valgus alignment, and greater rectus femoris muscle activity, leading to anterior tibial displacement upon single-leg landing. Increased femoral anteversion may be a potential risk factor for anterior cruciate ligament injury.

Kaneko, Masaaki; Sakuraba, Keishoku

2013-01-01

245

Association between Femoral Anteversion and Lower Extremity Posture upon Single-leg Landing: Implications for Anterior Cruciate Ligament Injury.  

PubMed

[Purpose] Increased femoral anteversion may occur with hip internal rotation and valgus knee alignment upon landing and is considered a risk factor for anterior cruciate ligament injury. We examined the relationship between femoral anteversion and joint motion and muscle activity of the lower extremity in terms of the risk factors for anterior cruciate ligament injury. [Subjects] Sixteen healthy females were divided on the basis of femoral anteversion into low and high groups. [Methods] Femoral anteversion was assessed using Craig's test. We performed kinematic analysis and measured the electromyography activity of the lower extremity upon left single-leg landing. [Results] The high group had a significantly lower hip flexion angle and higher knee flexion and valgus angles than the low group. The rectus femoris showed significantly greater electromyography activities in the high group than in the low group. [Conclusion] These results suggest that increased femoral anteversion results in lower hip flexion angle, higher knee valgus alignment, and greater rectus femoris muscle activity, leading to anterior tibial displacement upon single-leg landing. Increased femoral anteversion may be a potential risk factor for anterior cruciate ligament injury. PMID:24259760

Kaneko, Masaaki; Sakuraba, Keishoku

2013-10-01

246

Behavior of the graft within the bone tunnels following anterior cruciate ligament reconstruction, studied by cinematic magnetic resonance imaging.  

PubMed

The behavior of a ligament graft following cruciate ligament reconstruction is still an area of limited knowledge. Cinematic magnetic resonance imaging (MRI) offers the possibility of visualizing the graft, including the graft tunnels and fixation during knee motion. Twenty-three patients underwent cinematic MRI (0. 2 T; Artoscan) mean 23.4 months (range 14-39 months) after autologous anterior cruciate ligament reconstruction (eight bone-tendon-bone, seven semitendinosus-gracilis, and eight iliotibial band). The images were read without knowledge of the clinical condition or the type of surgery performed. Signal intensity and continuity of the anterior cruciate ligament reconstruction and movement of the graft in the tibial or femoral tunnel anteriorly and posteriorly were noted. In two of the 23 patients the graft (semitendinosus-gracilis) moved in the tibial canal. The initial 9-mm tunnel had expanded by 2 mm in the anteroposterior direction at the entrance to the joint space. Only these two had a slight knee laxity, with a side-to-side difference in anterior translation measured by the KT-2000 of 4 and 5 mm. No movement was observed in any of the femoral tunnels. Cinematic MRI thus makes it possible to study graft behavior within the bone tunnels. PMID:10663317

Jørgensen, U; Thomsen, H S

2000-01-01

247

Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons.  

PubMed

We retrospectively reviewed 87 anterior cruciate ligament reconstructions using autogenous hamstring tendons with the Endobutton technique to investigate the relationship between bone tunnel enlargement and clinical outcome and to identify factors that contribute to the enlargement. The clinical outcome was evaluated using the Lysholm score and KT-1000 arthrometer. The location of the femoral tunnel with respect to Blumensaat's line, the tibial tunnel with respect to the tibial plateau, and the angle between the femoral tunnel and Blumensaat's line (femoral tunnel angle) were measured. Bone tunnel enlargement was observed in 32 patients (37%). Enlargement occurred in 22 of the femoral tunnels and 26 of the tibial tunnels. Enlargement of both tunnels occurred in 16 knees. There was no statistical difference in Lysholm scores or KT-1000 arthrometer measurements between the enlarged group and the unenlarged group. The femoral tunnel was placed more anteriorly in the enlarged femoral tunnel group than in the unenlarged femoral tunnel group. The tibial tunnel was placed more anteriorly in the enlarged tibial tunnel group than in the unenlarged tibial tunnel group. The femoral tunnel angle was significantly smaller in the enlarged femoral tunnel group than in the femoral unenlarged group. Gender, patient age, intraoperative isometricity, and graft size were not significant factors. Bone tunnel enlargement was not correlated with the clinical outcome measures. We conclude that the main factor associated with tunnel enlargement are the locations and angles of the tunnels. The windshield-wiper motion of the graft may be enhanced by changing tension in the graft due to tunnel malposition. An acute femoral tunnel angle may increase the mechanical stress on the anterior margin of the femoral tunnel. PMID:11522075

Segawa, H; Omori, G; Tomita, S; Koga, Y

2001-07-01

248

Nutrition of the anterior cruciate ligament. Effects of continuous passive motion  

SciTech Connect

Twelve freshly killed mature male rabbits were used to study the effects of continuous passive motion (CPM) on regional and overall nonvascular nutritional pathways of the anterior cruciate ligament (ACL). One hundred fifty microcuries of /sup 35/S-sulfate was injected intraarticularly into each knee joint. The right knee underwent CPM for 1 hour, while the left knee remained immobilized. Both knee joints were then isolated and immediately frozen. The ACLs were removed while still mostly frozen, and sectioned into anterior, middle, and posterior thirds for the six rabbits in Group 1, and proximal, middle, and distal thirds for the six rabbits in Group 2. In addition, quadriceps tendon samples were harvested from each limb of three rabbits. After appropriate processing, all samples were counted in a scintillation counter, and counts per minute per milligram of tissue were calculated. There was significantly higher uptake in rest extremity ACLs compared to CPM extremity ACLs (P = 0.0001). No significant difference was demonstrated in regional uptake comparing respective thirds of the ACL in either Group 1 or Group 2. Quadriceps tendon uptake trended higher in the limbs exposed to CPM compared to those maintained at rest (P = 0.14). The ACL uses diffusion as a primary nutrient pathway. CPM does not increase nutrient uptake by the ACL in this avascular model, but CPM may facilitate transport of metabolites out of the joint. No regional differences in uptake within the ACL occurred in either group.

Skyhar, M.J.; Danzig, L.A.; Hargens, A.R.; Akeson, W.H.

1985-11-01

249

Knee laxity after complete anterior cruciate ligament tear: a prospective study over 15 years.  

PubMed

There is limited knowledge of knee laxity in the long term after a complete anterior cruciate ligament (ACL) tear treated without ACL reconstruction. The aim of this study was (1) to describe the clinical course of knee laxity after a complete ACL tear over 15 years, and (2) to study the association between knee laxity and meniscal injuries and the development of knee osteoarthritis (OA). We studied 100 consecutive subjects [mean (SD) age 26 (8) years] presenting with acute ACL injury prospectively. The initial treatment in all subjects was knee rehabilitation without reconstructive surgery. The subjects were examined with Lachman's and pivot-shift tests at baseline, 6 weeks, 3 months, 1 year, 3 years and 15 years after the injury. Sagittal knee laxity was also evaluated with the KT-1000 arthrometer at the 15-year follow-up. During follow-up, 22 subjects were ACL reconstructed due to unacceptable knee instability. There was only a mild remaining knee laxity [median Lachman grade and pivot-shift test value of 1 on a 4-grade scale (0-3)] after 15 years in subjects treated without primary ACL reconstruction. Knees with higher anterior sagittal knee laxity 3 months after the injury had a worse long-term outcome with respect to meniscal injuries and knee OA development. PMID:20673249

Neuman, P; Kostogiannis, I; Fridén, T; Roos, H; Dahlberg, L E; Englund, M

2012-04-01

250

Tibiofemoral cartilage contact biomechanics in patients after reconstruction of a ruptured anterior cruciate ligament  

PubMed Central

We investigated the in-vivo cartilage contact biomechanics of the tibiofemoral joint in patients after reconstruction of a ruptured anterior cruciate ligament (ACL). A dual fluoroscopic and MR imaging technique was used to investigate the cartilage contact biomechanics of the tibiofemoral joint during in-vivo weight-bearing flexion of the knee in eight patients six months following clinically successful reconstruction of an acute isolated ACL rupture. The location of tibiofemoral cartilage contact, size of the contact area, cartilage thickness at the contact area, and magnitude of the cartilage contact deformation of the ACL-reconstructed knees were compared with those previously measured in intact (contralateral) knees and ACL-deficient knees of the same subjects. Contact biomechanics of the tibiofemoral cartilage after ACL reconstruction were similar to those measured in intact knees. However, at lower flexion, the abnormal posterior and lateral shift of cartilage contact location to smaller regions of thinner tibial cartilage that has been described in ACL-deficient knees persisted in ACL-reconstructed knees, resulting in an increase of the magnitude of cartilage contact deformation at those flexion angles. Reconstruction of the ACL restored some of the in vivo cartilage contact biomechanics of the tibiofemoral joint to normal. Clinically, recovering anterior knee stability might be insufficient to prevent postoperative cartilage degeneration due to lack of restoration of in vivo cartilage contact biomechanics.

Hosseini, Ali; Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

2012-01-01

251

Unilateral aplasia of both cruciate ligaments  

PubMed Central

Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL) footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral) tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments.

2010-01-01

252

The effect of soft-tissue graft fixation in anterior cruciate ligament reconstruction on graft-tunnel motion under anterior tibial loading  

Microsoft Academic Search

Purpose: To compare the motion of an anterior cruciate ligament (ACL) replacement graft within the femoral bone tunnel (graft-tunnel motion) when a soft-tissue graft is secured either by a titanium button and polyester tape (EndoButton fixation; Acufex, Smith & Nephew, Mansfield, MA) or by a biodegradable interference screw (Biointerference fixation; Endo-fix; Acufex, Smith & Nephew) An additional purpose was to

Eiichi Tsuda; Yukihisa Fukuda; John C. Loh; Richard E. Debski; Freddie H. Fu; Savio L. Y. Woo

2002-01-01

253

Magnetic Resonance Imaging of Bioabsorbable Polylactic Acid Interference Screws During the First 2 Years After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Summary: Bioabsorbable screws composed of poly(L-lactic acid) (PLA) were used for graft fixation and studied prospectively with serial magnetic resonance imaging (MRI) scans at 8, 16, and 24 months after autogenous patellar tendon anterior cruciate ligament (ACL) reconstruction in 10 patients. Conventional spin echo, proton density , and T2-weighted double echo sequences were obtained, as well as T2-weighted fat-saturated fast

William H. Warden; Robert Friedman; Louis M. Teresi; Douglas W. Jackson

1999-01-01

254

A Randomized Controlled Trial Comparing the Effectiveness of Functional Knee Brace and Neoprene Sleeve Use After Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Despite a lack of evidence for their effectiveness, functional knee braces are commonly prescribed to patients after anterior cruciate ligament (ACL) reconstruction.Purpose: This trial was conducted to compare postoperative outcomes in patients using an ACL functional knee brace and patients using a neoprene knee sleeve.Hypothesis: Patients using a brace will have superior outcomes than those using a sleeve.Study Design:

Trevor B. Birmingham; Dianne M. Bryant; J. Robert Giffin; Robert B. Litchfield; John F. Kramer; Allan Donner; Peter J. Fowler

2008-01-01

255

Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose  Based on biomechanical anatomical studies, double-bundle reconstruction of the anterior cruciate ligament (ACL) was introduced\\u000a to achieve better stability in the knee, particularly in respect of rotatory loads. An in vivo, computer-assisted, double-bundle\\u000a (DB) ACL reconstruction is superior to a single-bundle (SB) ACL reconstruction at reducing rotatory, and AP laxities of the\\u000a tibia at 20 degrees of knee flexion and also

Stephane Plaweski; Mathieu Grimaldi; Aurélien Courvoisier; Simon Wimsey

2011-01-01

256

Healing results of meniscal tears left in situ during anterior cruciate ligament reconstruction: a review of clinical studies  

Microsoft Academic Search

The presence of peripheral meniscal tears is common at the time of anterior cruciate ligament (ACL) reconstruction. Techniques\\u000a to preserve the maximum amount of meniscal tissue include “non operative” management (tear left alone, without repair or removal),\\u000a meniscus repair, partial meniscectomy. There is a lack of consensus guidelines about the management of peripheral stable meniscal\\u000a tears. When to remove, let

Nicolas Pujol; Philippe Beaufils

2009-01-01

257

Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees  

Microsoft Academic Search

Purpose: For patients who underwent anterior cruciate ligament (ACL) reconstruction and had an unstable bucket-handle tear and no other meniscus lesions or articular damage, we sought to determine if repair of the lateral meniscus was superior to partial meniscectomy with regard to subjective and objective results.Type of Study: Retrospective cohort study.Methods: Between 1982 and 1995, 91 patients met the inclusion

K. Donald Shelbourne; Michael D Dersam

2004-01-01

258

Are oral contraceptive use and menstrual cycle phase related to anterior cruciate ligament injury risk in female recreational skiers?  

Microsoft Academic Search

Oral contraceptive use and menstrual cycle phase are suggested to influence the risk of anterior cruciate ligament (ACL) injuries\\u000a in female athletes. However, only few data are available for recreational sports. Therefore, female recreational skiers with\\u000a a non-contact ACL injury and age-matched controls completed a self-reported questionnaire relating to menstrual history, oral\\u000a contraceptive use and previous knee injuries. Menstrual history

Gerhard Ruedl; Patrick Ploner; Ingrid Linortner; Alois Schranz; Christian Fink; Renate Sommersacher; Elena Pocecco; Werner Nachbauer; Martin Burtscher

2009-01-01

259

Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament ReconstructionData From the Swedish Knee Ligament Register  

Microsoft Academic Search

Background: Female gender is a risk factor for sustaining anterior cruciate ligament (ACL) injury. However, little is known about possible sex differences in patients with ACL injury\\/reconstruction.Purpose: To study sex differences in patient-reported outcomes before and at 1 and 2 years after ACL reconstruction and to present reference values.Study Design: Cohort study; Level of evidence, 2.Methods: Between 2005 and 2008,

Eva Ageberg; Magnus Forssblad; Pär Herbertsson; Ewa M. Roos

2010-01-01

260

Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study  

Microsoft Academic Search

There has been an intensive research effort directed at determining the cause of non-contact anterior cruciate ligament (ACL) injury over the past decade, but few studies have reported data on the incidence of ACL and other knee ligament injury in the general population. New Zealand’s no-fault injury compensation data provides a national injury resource of data on claims for knee

Simon M. Gianotti; Stephen W. Marshall; Patria A. Hume; Lorna Bunt

2009-01-01

261

Morphologic Characteristics Help Explain the Gender Difference in Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing  

Microsoft Academic Search

Background: Gender differences exist in anterior cruciate ligament (ACL) cross-sectional area and lateral tibial slope. Biomechanical principles suggest that the direction of these gender differences should induce larger peak ACL strains in females under dynamic loading.Hypothesis: Peak ACL relative strain during a simulated pivot landing is significantly greater in female ACLs than male ACLs.Study Design: Controlled laboratory study.Methods: Twenty cadaveric

David B. Lipps; Youkeun K. Oh; James A. Ashton-Miller; Edward M. Wojtys

2012-01-01

262

Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report  

PubMed Central

Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy. We present herein a previously unreported anterior cruciate ligament (ACL) reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI) and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An anterior drawer stress radiography of the involved knee at 36 months following surgery showed a 61% anterior translation of the tibia. The preoperative symptoms of instability resolved and the patient expressed a high degree of satisfaction with the result of her surgery.

2012-01-01

263

Repair of a complete anterior cruciate tear using prolotherapy: a case report  

PubMed Central

Objective and Importance Surgical reconstruction is considered definitive treatment for anterior cruciate ligament (ACL) tears but precise surgical indications are debated. Some patients are reluctant or inappropriate surgical candidates. Prolotherapy is a non-surgical injection therapy for chronic musculoskeletal pain and instability. This case report documents the non-surgical repair of a torn ACL using prolotherapy and at-home exercise. Clinical Presentation and Intervention The 18 year old female patient sustained a right knee injury during a downhill skiing accident. Magnetic Resonance Imaging (MRI) revealed a high-grade partial versus complete rupture; Lachman exam findings suggested a complete rupture. She deferred surgical treatment. At 21 weeks post-injury, with unstable gait, inability to climb stairs and more than 1 cm anterior drawer test, she consented to undergo prolotherapy injections. She received 7 prolotherapy sessions over a 15 week period. At-home exercises were initiated at the 3rd prolotherapy session. Results The patient improved. Walking on flat ground improved 4 weeks after initiation of prolotherapy; she could ride a stationary bicycle for 30 minutes by 12 weeks. By 15 weeks, the patient had no instability climbing and descending stairs, the anterior drawer test was negative and MRI showed an intact ACL with fibrosis. Subsequently, she returned to full sport activity. Conclusions We document the non-surgical repair of a high-grade partial or complete ACL tear using prolotherapy and at-home exercise. Prolotherapy may be an alternative to surgery in carefully selected patients. This report is consistent with findings of recent pilot-level studies and suggests the need for rigorous clinical trials assessing prolotherapy as treatment for ligament and tendon injury in selected patients.

Grote, Walter; Delucia, Rosa; Waxman, Robert; Zgierska, Aleksandra; Wilson, John; Rabago, David

2010-01-01

264

Repair of a complete anterior cruciate tear using prolotherapy: a case report.  

PubMed

OBJECTIVE AND IMPORTANCE: Surgical reconstruction is considered definitive treatment for anterior cruciate ligament (ACL) tears but precise surgical indications are debated. Some patients are reluctant or inappropriate surgical candidates. Prolotherapy is a non-surgical injection therapy for chronic musculoskeletal pain and instability. This case report documents the non-surgical repair of a torn ACL using prolotherapy and at-home exercise. CLINICAL PRESENTATION AND INTERVENTION: The 18 year old female patient sustained a right knee injury during a downhill skiing accident. Magnetic Resonance Imaging (MRI) revealed a high-grade partial versus complete rupture; Lachman exam findings suggested a complete rupture. She deferred surgical treatment. At 21 weeks post-injury, with unstable gait, inability to climb stairs and more than 1 cm anterior drawer test, she consented to undergo prolotherapy injections. She received 7 prolotherapy sessions over a 15 week period. At-home exercises were initiated at the 3(rd) prolotherapy session. RESULTS: The patient improved. Walking on flat ground improved 4 weeks after initiation of prolotherapy; she could ride a stationary bicycle for 30 minutes by 12 weeks. By 15 weeks, the patient had no instability climbing and descending stairs, the anterior drawer test was negative and MRI showed an intact ACL with fibrosis. Subsequently, she returned to full sport activity. CONCLUSIONS: We document the non-surgical repair of a high-grade partial or complete ACL tear using prolotherapy and at-home exercise. Prolotherapy may be an alternative to surgery in carefully selected patients. This report is consistent with findings of recent pilot-level studies and suggests the need for rigorous clinical trials assessing prolotherapy as treatment for ligament and tendon injury in selected patients. PMID:20802815

Grote, Walter; Delucia, Rosa; Waxman, Robert; Zgierska, Aleksandra; Wilson, John; Rabago, David

2009-12-01

265

Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system): a systematic review  

PubMed Central

Background Injury to the anterior cruciate ligament (ACL) of the knee is common. Following complete rupture of the ACL, insufficient re-vascularization of the ligament prevents it from healing completely, creating a need for reconstruction. A variety of grafts are available for use in ACL reconstruction surgery, including synthetic grafts. Over the last two decades new types of synthetic ligaments have been developed. One of these synthetic ligaments, the Ligament Advanced Reinforcement System (LARS), has recently gained popularity. The aim of this systematic review was to assess the current best available evidence for the effectiveness of the LARS as a surgical option for symptomatic, anterior cruciate ligament rupture in terms of graft stability, rehabilitation time and return to pre-injury function. Method This systematic review included studies using subjects with symptomatic, ACL ruptures undergoing LARS reconstruction. A range of electronic databases were searched in May 2010. The methodological quality of studies was appraised with a modified version of the Law critical appraisal tool. Data relating to study characteristics, surgical times, complication rates, outcomes related to knee stability, quality of life, function, and return to sport as well as details of rehabilitation programs and timeframes were collected. Results This review identified four studies of various designs, of a moderate methodological quality. Only one case of knee synovitis was reported. Patient satisfaction with LARS was high. Graft stability outcomes were found to be inconsistent both at post operative and at follow up periods. The time frames of rehabilitation periods were poorly reported and at times omitted. Return to pre-injury function and activity was often discussed but not reported in results. Conclusions There is an emerging body of evidence for LARS with comparable complication rates to traditional surgical techniques, and high patient satisfaction scores. However, this systematic review has highlighted several important gaps in the existing literature that require future prospective investigation. The findings of this review were equivocal with regards to other measures such as graft stability and long term functional outcomes. While the importance of rehabilitation following LARS is well recognised, there is limited evidence to guide rehabilitation protocols.

2010-01-01

266

[Reconstruction of the knee anterior cruciate ligament: single or double bundle?].  

PubMed

Anatomical and biomechanical studies have shown that the anterior cruciate ligament (ACL) consists of two distinct bundles, the anteromedial (AM) and posterolateral. Each bundle has its specific role during the motion of the knee. ACL reconstruction techniques have focused on the restauration of the anteroposterior stability by substituting the more isometric AM bundle. Although these ligamentoplasties provide overall good results, in the last ten years double-bundle ACL reconstruction techniques have been developed, to better replicate the ligament anatomy. Despite the growing number of published studies, including randomized controlled trials comparing single bundle and double bundle reconstructions, there is still a lack of evidence of any superiority of the double-bundle technique. Furthermore, many series are criticized for their poor assessement of rotational stability, using most of the time subjective pivot shift clinical testing. Among the methods available to measure tibial rotation, 3-D optoelectronic evaluation is an attractive tool and has been used in some studies reporting rotational mesurements after ACL single-bundle reconstruction. Our Department of Orthopaedics and Traumatology has been using double-bundle techniques for a few years. We conducted a preliminary prospective randomized study, in order to compare single and double-bundle techniques by clinical and optoelectronic evaluations. PMID:22458064

Cermak, K; Baillon, B; Bruynseels, K; Salvia, P; Feipel, V; Remy, P; Vancabeke, M; Rooze, M

2011-01-01

267

The phenomenon of "ligamentization": anterior cruciate ligament reconstruction with autogenous patellar tendon.  

PubMed

Reconstruction of the anterior cruciate ligament (ACL) with patellar tendon (PT) is a common procedure for the symptomatic ACL-deficient knee. Questions regarding graft incorporation, viability, and nutrition of the transplanted tissue are of concern. This relates to the graft's response to its new intrasynovial milieu and new physical forces. These factors were studied in a rabbit model of ACL reconstruction using PT and were evaluated with histological and biochemical parameters with respect to time. A histological and biochemical metamorphosis of the grafted PT occurred in this study. Autografts demonstrated a gradual assumption of the microscopic properties of normal ACL; by 30 weeks postoperatively, cell morphology was ligamentous in appearance. Normally, type III collagen is not observed in PT, however, a gradual increase in its concentration was seen in the grafts; by 30 weeks its concentration (10%) was the same as in normal ACL. Similarly, glycosaminoglycans content increased from its normally low level in PT to that found in native ACL. Collagen-reducible crosslink analysis demonstrated that grafted tissue changed from the normal PT pattern of low dihydroxylysinonorleucine (DHLNL) and high histidinohydroxymerodesmosine (HHMD) to the pattern seen in normal ACL (high DHLNL and low HHMD) by 30 weeks. These data suggest that when PT is placed in the anatomic and environmental milieu of the ACL, a "ligamentization" of the grafted tissue results; also the autograft initially depends on synovial fluid nutrition, as revascularization occurs after 6 weeks. PMID:3712125

Amiel, D; Kleiner, J B; Roux, R D; Harwood, F L; Akeson, W H

1986-01-01

268

Isolated hip and ankle fatigue are unlikely risk factors for anterior cruciate ligament injury.  

PubMed

Lower extremity neuromuscular fatigue purportedly increases anterior cruciate ligament (ACL) injury risk through promotion of extreme landing mechanics. However, the impact of fatigue on muscle groups critical to the landing strategy remains unclear. This study examined the effects of isolated hip rotator and triceps surae fatigue on lower extremity landing biomechanics. Sixteen healthy females (18-22 years) reported for testing on two occasions, with one muscle group fatigued per session. Subjects performed three single-leg landings onto a force platform pre- and post-fatigue, defined as an 80% decrease in peak torque in the targeted muscle group. Hip rotator fatigue was induced via alternating concentric contractions and triceps surae fatigue through concentric plantar flexion contractions on an isokinetic dynamometer. Initial contact (IC) kinematics and peak stance (PS) kinetics and kinematics were analyzed pre- and post-fatigue. Hip rotator fatigue increased IC (P=0.05) and PS (P=0.04) hip internal rotation angles. Triceps surae fatigue decreased IC knee flexion (P=0.01) angle. Isolated hip rotator and triceps surae fatigue each produced modifications in lower limb kinematic parameters viewed as risk factors for ACL injury. These modifications, however, do not appear of sufficient magnitude to compromise ligament integrity, suggesting injury via an integrative lower extremity fatigue mechanism is more likely. PMID:20136750

Thomas, A C; Palmieri-Smith, R M; McLean, S G

2011-06-01

269

Influence of age on osteoarthritis progression after anterior cruciate ligament transection in rats.  

PubMed

The anterior cruciate ligament transection (ACLT) model of osteoarthritis (OA) in young rats is widely used to study the pathogenesis of OA and possible treatment approaches. As aging is a key factor in the progression of this condition, it is hypothesized that animals may vary in their responses to ACLT according to their age. The histopathological features of young (2month-old) and middle-aged (12month-old) rats in the presence or absence of ACLT were compared. The results indicated that moderate degradative changes can be detected in the knee joints of sham-operated middle-aged rats compared with young animals. After ACLT, cartilage degradation was significantly higher in middle-aged rats in relation to young animals. An increase in interleukin(IL)-1? and IL-17 suggests the presence of a local inflammatory response represented by synovitis in ACLT rats which is not dependent on age. Our study indicates that age is an important factor affecting the pathogenesis of OA changes after ACLT and it should be considered in studies using this experimental model. PMID:24667123

Ferrándiz, María Luisa; Terencio, María Carmen; Ruhí, Ramón; Vergés, Josep; Montell, Eulàlia; Torrent, Anna; Alcaraz, María José

2014-07-01

270

Current practice variations in the management of anterior cruciate ligament injuries in Croatia  

PubMed Central

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature.

Mahnik, Alan; Mahnik, Silvija; Dimnjakovic, Damjan; Curic, Stjepan; Smoljanovic, Tomislav; Bojanic, Ivan

2013-01-01

271

Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: a systematic review.  

PubMed

This review describes the psychosocial factors that affect recovery following anterior cruciate ligament (ACL) injury and reconstructive surgery in athletes. A systematic search in literature with inclusion and exclusion criteria on PubMed, PsycINFO, and Embase was performed. Articles used in this review were divided in five different parts according to the biopsychosocial model of Wiese-Bjornstal, with the addition of intervention studies. The results showed that a high internal Health Locus of Control and a high self-efficacy were useful cognitive factors to facilitate the recovery. Athletes with a low level of fear of reinjury had the best knee outcome after the injury followed by a reconstruction. In addition, athletes who returned to sport had less fear of reinjury and were more experienced and established athletes compared with athletes who did not return to sport. Furthermore, researchers showed that there was a positive relation between goal setting and adherence, which in turn yielded a positive relation with the outcome of the rehabilitation of an ACL injury. There were several psychosocial interventions that appeared to be facilitating the rehabilitation process. PMID:23121478

te Wierike, S C M; van der Sluis, A; van den Akker-Scheek, I; Elferink-Gemser, M T; Visscher, C

2013-10-01

272

Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor  

NASA Astrophysics Data System (ADS)

Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

2007-12-01

273

Biology of anterior cruciate ligament injury and repair: Kappa delta ann doner vaughn award paper 2013.  

PubMed

Anterior cruciate ligament (ACL) injuries are currently treated by removing the injured ligament and replacing it with a tendon graft. Recent studies have examined alternative treatment methods, including repair and regeneration of the injured ligament. In order to make such an approach feasible, a basic understanding of ACL biology and its response to injury is needed. Identification of obstacles to native ACL healing can then be identified and potentially resolved using tissue engineering strategies-first, with in vitro screening assays, and then with in vivo models of efficacy and safety. This Perspectives paper outlines this path of discovery for optimizing ACL healing using a bio-enhanced repair technique. This journey required constructing indices of the functional tissue response, pioneering physiologically based methods of biomechanical testing, developing, and validating clinically relevant animal models, and creating and optimizing translationally feasible scaffolds, surgical techniques, and biologic additives. Using this systematic translational approach, "bio-enhanced" ACL repair has been advanced to the point where it may become an option for future treatment of acute ACL injuries and the prevention of subsequent post-traumatic osteoarthritis associated with this injury. PMID:23818453

Murray, Martha Meaney; Fleming, Braden C

2013-10-01

274

Comparison of knee mechanics among risky athletic motions for noncontact anterior cruciate ligament injury.  

PubMed

It has been suggested that noncontact anterior cruciate ligament injury commonly occurs during sports requiring acute deceleration or landing motion and that female athletes are more likely to sustain the injury than male athletes. The purpose of this study was to make task-to-task and male-female comparisons of knee kinematics and kinetics in several athletic activities. Three-dimensional knee kinematics and kinetics were investigated in 20 recreational athletes (10 males, 10 females) while performing hopping, cutting, turning, and sidestep and running (sharp deceleration associated with a change of direction). Knee kinematics and kinetics were compared among the four athletic tasks and between sexes. Subjects exhibited significantly lower peak flexion angle and higher peak extension moment in hopping compared with other activities (P < .05). In the frontal plane, peak abduction angle and peak adduction moment in cutting, turning, and sidestep and running were significantly greater compared with hopping (P < .05). No differences in knee kinematics and kinetics were apparent between male and female subjects. Recreational athletes exhibited different knee kinematics and kinetics in the four athletic motions, particularly in the sagittal and frontal planes. Male and female subjects demonstrated similar knee motions during the four athletic activities. PMID:23434840

Tanikawa, Hidenori; Matsumoto, Hideo; Komiyama, Ikki; Kiriyama, Yoshimori; Toyama, Yoshiaki; Nagura, Takeo

2013-12-01

275

Expression of modulators of extracellular matrix structure after anterior cruciate ligament injury.  

PubMed

The ability of the anterior cruciate ligament (ACL) to heal after injury declines within the first 2 weeks after ACL rupture. To begin to explore the mechanism behind this finding, we quantified the expression of genes for collagen I and III, decorin, tenascin-C, and alpha smooth muscle actin, as well as matrix metalloproteinase (MMP)-1 and -13 gene expression within multiple tissues of the knee joint after ACL injury in a large animal model over a 2-week postinjury period. Gene expression of collagen I and III, decorin, and MMP-1 was highest in the synovium, whereas the highest MMP-13 gene expression levels were found in the ACL. The gene expression for collagen and decorin increased over the 2 weeks to levels approaching that in the ligament and synovium; however, no significant increase in either of the MMPs was found in the provisional scaffold. This suggests that although the ACL and synovium up-regulate both anabolic and catabolic factors, the provisional scaffold is primarily anabolic in function. The relative lack of provisional scaffold formation within the joint environment may thus be one of the key reasons for ACL degradation after injury. PMID:24393158

Haslauer, Carla M; Proffen, Benedikt L; Johnson, Victor M; Murray, Martha M

2014-01-01

276

Predictors of Adherence to Home Rehabilitation Exercises Following Anterior Cruciate Ligament Reconstruction  

PubMed Central

Purpose/Objective Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery. Research Method/Design Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively. Results Participants reported a high level of adherence to the prescribed regimen. Home exercise completion increased significantly over time as the number of sets of prescribed home exercises declined. Personal factors were not predictive of home exercise completion. Participants completed fewer home exercises on days when they experienced more stress or negative mood. Conclusions/Implications Day-to-day variations in negative mood and stress may contribute to adherence to prescribed home exercises.

Brewer, Britton W.; Cornelius, Allen E.; Van Raalte, Judy L.; Tennen, Howard; Armeli, Stephen

2014-01-01

277

Tensile properties of rat anterior cruciate ligament in collagen induced arthritis  

PubMed Central

OBJECTIVES—To investigate the effects of collagen induced arthritis (CIA) on the tensile properties of rat anterior cruciate ligament (ACL).?METHODS—The tensile strength, bone mineral density (BMD), and histology of ACL units from rats with CIA were investigated.?RESULTS—The tensile strength of the ACL unit was significantly lower in the rats with CIA at 10 weeks after immunisation (ultimate failure load, 74.9% of the control; stiffness, 62.0% of the control). The major mode of failure was femoral avulsion, and the BMD was significantly lower in the rats with CIA. A histological examination of the ligament insertion in rats with CIA showed resorption of the cortical bone beneath the ACL insertion and an enlarged mineralised fibrocartilage zone.?CONCLUSIONS—These findings indicate that the decrease in tensile strength of ACL units correlated with histological changes in the ligament-bone attachment, such as bone resorption beneath the ligament insertion site and an enlargement of the mineralised fibrocartilage zone.??

Nawata, K; Enokida, M; Yamasaki, D; Minamizaki, T; Hagino, H; Morio, Y; Teshima, R

2001-01-01

278

Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks.  

PubMed

The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees. PMID:24837218

Takeda, Kentaro; Hasegawa, Takayuki; Kiriyama, Yoshimori; Matsumoto, Hideo; Otani, Toshiro; Toyama, Yoshiaki; Nagura, Takeo

2014-07-18

279

All-Epiphyseal, All-Inside Anterior Cruciate Ligament Reconstruction Technique for Skeletally Immature Patients  

PubMed Central

Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the juvenile population. Unfortunately, outcomes with conservative treatment are extremely poor. Adult reconstruction techniques are inappropriate to treat skeletally immature patients because of the risk of physeal complications, including limb-length discrepancy and angular deformities. “Physeal-sparing” reconstruction techniques exist, but their ability to restore knee stability is not well understood. We describe an all-epiphyseal ACL reconstruction for use in skeletally immature patients. This is an all-inside technique with the femoral tunnel drilled retrograde and the tibial tunnel drilled retrograde; both tunnels are entirely within the epiphysis. Fixation of the hamstring autograft is achieved with soft-tissue buttons on both the femur and tibia. We present case examples for 2 patients who underwent the all-inside, all-epiphyseal reconstruction and our postoperative rehabilitation protocol. We present a novel surgical technique for an all-inside, all-epiphyseal ACL reconstruction in skeletally immature patients.

McCarthy, Moira M.; Graziano, Jessica; Green, Daniel W.; Cordasco, Frank A.

2012-01-01

280

Anterior cruciate ligament laxity related to the menstrual cycle: an updated systematic review of the literature  

PubMed Central

Objectives: The purpose of this study was to conduct a systematic review regarding the purported differences in anterior cruciate ligament (ACL) laxity throughout the course of the menstrual cycle. Methods: A systematic review was performed by searching electronic databases, along with hand-searching of journals and reference tracking for any study that assessed ACL integrity throughout the menstrual cycle from 1998 until 2011. Studies that met the pre-defined inclusion criteria were evaluated using the Modified Sackett Score (MSS) instrument that assessed their methodological quality. Results: Thirteen articles out of a possible 28 met the inclusion criteria. Conclusions: This systematic review found 13 clinical trials investigating the effect of the menstrual cycle on ACL laxity. There is evidence to support the hypothesis that the ACL changes throughout the menstrual cycle, with it becoming more lax during the pre-ovulatory (luteal) phase. Overall, these reviews found statistically significant differences for variation in ACL laxity and injury throughout the menstrual cycle, especially during the pre-ovulatory phase. Female athletes may need to take precautions in order to reduce the likelihood of ACL injury. However, the quality of the assessments was low and the evidence is still very limited. More and better quality research is needed in this area.

Belanger, Lesley; Burt, Dawn; Callaghan, Julia; Clifton, Sheena; Gleberzon, Brian J.

2013-01-01

281

Development of cell-seeded patellar tendon allografts for anterior cruciate ligament reconstruction.  

PubMed

Patellar tendon (PT) allografts for anterior cruciate ligament (ACL) reconstruction are potentially immunogenic and incorporate slowly compared with autografts. Our tissue-engineering approach to improve allograft efficacy is to (1) remove intrinsic cells from the graft to reduce antigenicity and then (2) seed the graft with extrinsic cells to improve ligamentization. To remove cells, tendons were soaked in 1% extraction solutions of tri(n-butyl)phosphate (TBP) or sodium dodecyl sulfate (SDS) for various time periods (24-72 h) and rinsed exhaustively. After treatment, we measured tendon cellularity, crimp structure, and mechanical properties. Treatment with either SDS or TBP removed approximately 70-90% of the intrinsic PT cells. Mechanical properties of treated PTs were similar to those of controls, despite changes in appearance. TBP- and SDS-treated PTs were then seeded with fibroblasts and cultured for up to 2 weeks in vitro. Fibroblast proliferation was retarded on SDS-treated PTs; in contrast, TBP-treated PTs supported cell proliferation similar to that of untreated controls. Extrinsic fibroblasts were successfully cultured on the TBP-treated PTs in vitro, creating viable tissue-engineered grafts potentially useful for ACL reconstruction. These modified allografts have the potential to be developed into mechanically functional delivery vehicles for cells, gene therapy vectors, or other biological agents. PMID:15363164

Cartmell, Jeffrey S; Dunn, Michael G

2004-01-01

282

Quadriceps strength and weight acceptance strategies continue to improve two years after anterior cruciate ligament reconstruction  

PubMed Central

The anterior cruciate ligament (ACL) is the most commonly-injured knee ligament during sporting activities. After injury, most individuals experience episodes of the knee giving way during daily activities (non-copers). Non-copers demonstrate asymmetrical quadriceps strength and movement patterns which could have long-term deleterious effects on the integrity of the knee joint. The purpose of this study was to determine if non-copers resolve their strength and movement asymmetries within two years after surgery. 26 non-copers were recruited to undergo pre-operative quadriceps strength testing and 3-dimensional gait analysis. Subjects underwent surgery to reconstruct the ligament followed by physical therapy focused on restoring normal range of motion, quadriceps strength, and function. Subjects returned for quadriceps strength testing and gait analysis six months and two years after surgery. Acutely after injury, quadriceps strength was asymmetric between limbs, but resolved six months after surgery. Asymmetric knee angles, knee moments, and knee and hip power profiles were also observed acutely after injury and persisted six months after surgery despite subjects achieving symmetrical quadriceps strength. Two years after surgery, quadriceps strength in the involved limb continued to improve and most kinematic and kinetic asymmetries resolved. These findings suggest that adequate quadriceps strength does not immediately resolve gait asymmetries in non-copers. They also suggest that non-copers have the capacity to improve their quadriceps strength and gait symmetry long after ACL reconstruction.

Roewer, Ben D.; Di Stasi, Stephanie L.; Snyder-Mackler, Lynn

2011-01-01

283

Patellar tendon ossification after anterior cruciate ligament reconstruction using bone - patellar tendon - bone autograft  

PubMed Central

Background Among the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature. Case presentation We present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative. Conclusion The surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.

2013-01-01

284

Three-Dimensional Fluoroscopic Navigation Guidance for Femoral Tunnel Creation in Revision Anterior Cruciate Ligament Reconstruction  

PubMed Central

Revision anterior cruciate ligament (ACL) reconstruction is accompanied by several technical challenges that must be addressed, such as a primary malpositioned bone tunnel, pre-existing hardware, or bone defects due to tunnel expansion. We describe a surgical technique used to create an anatomic femoral socket using a 3-dimensional (3D) fluoroscopy-based navigation system in technically demanding revision cases. After a reference frame is rigidly attached to the femur, an intraoperative image of the distal femur is obtained, which is transferred to a navigation system and reconstructed into a 3D image. A navigation computer helps the surgeon to visualize the whole image of the lateral wall of the femoral notch, even if the natural morphology of the intercondylar notch has been destroyed by the primary procedure. In addition, the surgeon can also confirm the position of the previous bone tunnel aperture, the previous exit of the femoral tunnel, and the presence of any pre-existing hardware on the navigation monitor. When a new femoral guidewire for the revision procedure is placed, the virtual femoral tunnel is overlaid on the reconstructed 3D image in real time. At our institution, 12 patients underwent 1-stage revision ACL procedures with the assistance of this computer navigation system, and the grafts were securely fixed in anatomically created tunnels in all cases. This technology can assist surgeons in creating anatomic femoral tunnels in technically challenging revision ACL reconstructions.

Taketomi, Shuji; Inui, Hiroshi; Nakamura, Kensuke; Hirota, Jinso; Takei, Seira; Takeda, Hideki; Tanaka, Sakae; Nakagawa, Takumi

2012-01-01

285

Stability comparison of anterior cruciate ligament between double- and single-bundle reconstructions  

PubMed Central

The purpose of this study was to evaluate the intra-operative stability during double-bundle anterior cruciate ligament (ACL) reconstructions (20 knees) using a navigation system and compare the results with those obtained from single-bundle reconstructions (20 knees). After registering the reference points during ACL reconstruction, antero-posterior and rotational stability tests with 30° knee flexion using a navigation system were measured before and after reconstructions on both groups. The change of antero-posterior translation after and before reconstruction was 12.5 mm in the double-bundle group and 10.5 mm in the single-bundle group, showing significant inter-group difference (p=0.014, from 17.5 mm to 5.1 mm in the double-bundle and from 16.6 mm to 6.1 mm in the single-bundle group). The mean rotational stability of the double-bundle group also showed more significant improvement after reconstruction compared to that of the single-bundle group (9.8° in the double- and 5.6° in the single-bundle groups, p<0.001). These findings suggest that a double-bundle ACL reconstruction restores greater knee stability with respect to the antero-posterior and rotational stability than a single-bundle reconstruction.

Seon, Jong Keun; Park, Sang Jin; Lee, Keun Bae; Yoon, Taek Rim; Seo, Hyoung Yeon

2008-01-01

286

Measurement of functional recovery in individuals with acute anterior cruciate ligament rupture  

PubMed Central

Objectives: To measure functional recovery following acute anterior cruciate ligament (ACL) rupture using a simple and reliable clinical movement analysis system. Clinic based methods that simultaneously quantify different aspects of movement over a range of activities and model functional recovery will help guide rehabilitation. Methods: A longitudinal study was used to measure gait variables at initial physiotherapy attendance and then at monthly intervals using a digital camcorder and computer for quantitative analysis. Jogging and distance hopping were added during recovery. A sample of 63 ACL deficient subjects entered the study and 48 subjects were measured at least three times. To determine the pattern of recovery, repeated measurements were analysed using a least square fit of the data. Results: Gait variables took between 95 and 130 days post injury to reach the control mean and stabilise shortly after this. Hopping distance for the injured leg took 62 days to recover to within normal limits and 5 months post injury to reach the control mean. Jogging was already within the control limits at 30 days post injury and demonstrated little change with recovery. Conclusions: Functional recovery of multiple variables has been modelled. In the early phase of post injury, gait velocity seems to be the most useful variable to measure improvement. Recovery of more challenging activities appears to take an average of 5 months. Therefore, patients may need to be monitored in physiotherapy until this time and advised not to return to sport until sufficient recovery is demonstrated on activities such as distance hopping.

Button, K; van Deursen, R; Price, P; Rosenbaum, D

2005-01-01

287

Assessing post-anterior cruciate ligament reconstruction ambulation using wireless wearable integrated sensors.  

PubMed

Abstract A hardware/software co-design for assessing post-Anterior Cruciate Ligament (ACL) reconstruction ambulation is presented. The knee kinematics and neuromuscular data during walking (2-6 km?h(-1)) have been acquired using wireless wearable motion and electromyography (EMG) sensors, respectively. These signals were integrated by superimposition and mixed signals processing techniques in order to provide visual analyses of bio-signals and identification of the recovery progress of subjects. Monitoring overlapped signals simultaneously helps in detecting variability and correlation of knee joint dynamics and muscles activities for an individual subject as well as for a group. The recovery stages of subjects have been identified based on combined features (knee flexion/extension and EMG signals) using an adaptive neuro-fuzzy inference system (ANFIS). The proposed system has been validated for 28 test subjects (healthy and ACL-reconstructed). Results of ANFIS showed that the ambulation data can be used to distinguish subjects at different levels of recuperation after ACL reconstruction. PMID:24117351

Arosha Senanayake, S M N; Ahmed Malik, Owais; Mohammad Iskandar, Pg; Zaheer, Dansih

2013-11-01

288

Investigation of a hybrid method of soft tissue graft fixation for anterior cruciate ligament reconstruction.  

PubMed

To increase knee stability following anterior cruciate ligament (ACL) reconstruction, development of increasingly stronger and stiffer fixation is required. This study assessed the initial pullout force, stiffness of fixation, and failure modes for a novel hybrid fixation method combining periosteal and direct fixation using porcine femoral bone. A soft tissue graft was secured by combining both an interference screw and an EndoButton (Smith and Nephew Endoscopy, Andover, MA). The results were compared with the traditional direct fixation method using a titanium interference screw. Twenty porcine hindlimbs were divided into two groups. Specimens were loaded in line with the bone tunnel on a materials testing machine. Maximum pullout force of the hybrid fixation (588+/-37 N) was significantly greater than with an interference screw alone (516+/-37 N). The stiffness of the hybrid fixation (52.1+/-12.8 N/mm) was similar to that of screw fixation (56.5+/-10.2 N/mm). Graft pullout was predominant for screw fixation, whereas a combination of graft pullout and graft failure was seen for hybrid fixation. These results indicate that initial pullout force of soft tissue grafts can be increased by using the suggested novel hybrid fixation method. PMID:15749452

Au, Anthony G; Otto, David D; Raso, V James; Amirfazli, Alidad

2005-04-01

289

Vascular structure and function in the medial collateral ligament of anterior cruciate ligament transected rabbit knees.  

PubMed

To determine if decreased vascular responsiveness in the medial collateral ligament (MCL) of anterior cruciate ligament transected (ACL-t) rabbit knees is due to pericyte deficiency associated with angiogenesis. Vascular responses to potassium chloride (KCl), phenylephrine, acetylcholine, and sodium nitroprusside (SNP) were evaluated in ACL-t rabbit knees (n?=?6) and control knees (n?=?5) using laser speckle perfusion imaging. Ligament degeneration was determined by ultrasound imaging. Vascular and pericyte volume were measured using quantitative immunohistochemical volumetric analysis using CD31 and ?-smooth muscle actin antibodies with co-localization analysis. Perfusion was increased in the ACL-t rabbits 2.5-fold. Responsiveness to phenylephrine, SNP, and acetylcholine was significantly decreased in the ACL knee while no change in KCl responses was seen. MCL ultrasound imaging revealed decreased collagen organization, increased ligament thickness, and increased water content in the ACL-t MCL. Vascular Volume was increased fourfold in ACL deficient knees, while pericyte volume to endothelial volume was not changed. No difference in CD31 and ?-SMA co-localization was found. Blood vessels in the MCL of ACL-t knees do not lack smooth muscle. The MCL vasculature can undergo constrictive response to KCl, but have impaired receptor mediated responses and impaired nitric oxide signaling. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1104-1110, 2014. PMID:24909758

Miller, Daniel; DeSutter, Christopher; Scott, Alex; Koglin, Laurent; Hart, David A; Salo, Paul; Leonard, Catherine; Mammoto, Takeo; Bray, Robert C

2014-09-01

290

Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: soccer.  

PubMed

Successful return to play remains a challenge for a soccer player after anterior cruciate ligament reconstruction. In addition to a successful surgical intervention, a soccer-specific functional rehabilitation program is essential to achieve this goal. Soccer-like elements should be incorporated in the early stages of rehabilitation to provide neuromuscular training specific to the needs of the player. Gym-based and, later, field-based drills are gradually intensified and progressed until the player demonstrates the ability to return to team practice. In addition to the recovery of basic attributes such as mobility, flexibility, strength, and agility, the surgically repaired knee must also regain soccer-specific neuromuscular control and conditioning for an effective return to sports. The individual coaching of the player by the sports physiotherapist and compliance with the training program by the player are key factors in the rehabilitation process. To minimize reinjury risk and to maximize the player's career, concepts of soccer-specific injury prevention programs should be incorporated into the training routine during and after the rehabilitation of players post-ACL reconstruction. PMID:22467065

Bizzini, Mario; Hancock, Dave; Impellizzeri, Franco

2012-04-01

291

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics  

PubMed Central

Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom.

Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

2009-01-01

292

Effect of Perturbing a Simulated Motion on Knee and Anterior Cruciate Ligament Kinetics  

PubMed Central

Current surgical treatments for common knee injuries do not restore the normal biomechanics. Among other factors, the abnormal biomechanics increases the susceptibility to the early onset of osteoarthritis. In pursuit of improving long term outcome, investigators must understand normal knee kinematics and corresponding joint and anterior cruciate ligament (ACL) kinetics during the activities of daily living. Our long term research goal is to measure in vivo joint motions for the ovine stifle model and later simulate these motions with a 6 degree of freedom (DOF) robot to measure the corresponding 3D kinetics of the knee and ACL-only joint. Unfortunately, the motion measurement and motion simulation technologies used for our project have associated errors. The objective of this study was to determine how motion measurement and motion recreation error affect knee and ACL-only joint kinetics by perturbing a simulated in vivo motion in each DOF and measuring the corresponding intact knee and ACL-only joint forces and moments. The normal starting position for the motion was perturbed in each degree of freedom by four levels (?0.50, ?0.25, 0.25, and 0.50 mm or degrees). Only translational perturbations significantly affected the intact knee and ACL-only joint kinetics. The compression-distraction perturbation had the largest effect on intact knee forces and the anterior-posterior perturbation had the largest effect on the ACL forces. Small translational perturbations can significantly alter intact knee and ACL-only joint forces. Thus, translational motion measurement errors must be reduced to provide a more accurate representation of the intact knee and ACL kinetics. To account for the remaining motion measurement and recreation errors, an envelope of forces and moments should be reported. These force and moment ranges will provide valuable functional tissue engineering parameters (FTEPs) that can be used to design more effective ACL treatments.

Herfat, Safa T.; Boguszewski, Daniel V.; Nesbitt, Rebecca J.

2013-01-01

293

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort  

PubMed Central

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature.

2013-01-01

294

Biomechanical comparisons of anterior cruciate ligament: reconstruction procedures with flexor tendon graft.  

PubMed

An experimental study was conducted to compare the biomechanical characteristics of six currently available anterior cruciate ligament (ACL) reconstruction procedures with flexor digitorum profundus tendons. Forty porcine knees were divided into eight groups, of 5 knees each. In groups A, B, C, and D, the flexor tendon graft was fixed with sutures and an Endobutton, with 20-mm-wide polyester tapes and staples, with 10-mm-wide polyester tapes and an Endobutton, and with bone plugs and interference screws, respectively. In group E, the graft was fixed using a combined procedure of those in groups B and D. In group F, the graft was directly fixed with interference screws. In groups G and H, the bone-patellar tendon-bone graft was fixed with interference screws, and sutures, respectively. Each femur-graft-tibia complex specimen was tested with a tensile tester by anteriorly translating the tibia until failure. This study demonstrated that the biomechanical properties of the femur-graft-tibia complex reconstructed with the flexor tendon graft were significantly affected by synthetic fixation devices. Regarding the average maximal load of the groups with the flexor tendon graft, group B had the highest (893 N) and group C had the second highest (770 N). Groups E and A were in the third rank. Group F had the second lowest (312 N), and Group D had the lowest (230 N). The maximal load of group B was significantly greater (P < 0.01) than that of group G (656 N) with the bone-patellar tendon-bone grafts. As to clinical relevance, this study indicated that the flexor tendon graft can be an alternative substitute for the bone-patellar tendon-bone graft for ACL reconstruction, if we understand the biomechanical characteristics of each reconstruction procedure. PMID:11180923

Miyata, K; Yasuda, K; Kondo, E; Nakano, H; Kimura, S; Hara, N

2000-01-01

295

Radiographic findings in revision anterior cruciate ligament reconstructions from the Mars cohort.  

PubMed

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

2013-08-01

296

Safe and effective quadriceps femoris muscle exercise of resisted front bridge with a leg support in patients with anterior cruciate ligament insufficiency  

Microsoft Academic Search

BackgroundMuscle strengthen exercise of quadriceps femoris is important but risky to the anterior cruciate ligament (ACL) graft, because quadriceps muscle exercise near the knee extension may causes anterior tibial translation. We developed a new exercise method, ‘resisted front bridge exercise with a leg support at proximal tibia’ (RFBP) in a prone position to avoid a risk. Our hypothesis is that

N Nakae; M Koyanagi; M Sato; T Sakai; Y Kimura; K Hidaka; K Nakata

2011-01-01

297

A Cadaver Study of the Structures and Positions of the Anterior Cruciate Ligament in Humans  

PubMed Central

Background: The anterior cruciate ligament (ACL) is one of the major knee structures. It consists of anteromedial bundle (AMB) and posterolateral bundle (PLB). Rupture of the ACL is one of the most prevalent traumas among athletes. There are two ways to reconstruct the rupture; Single–bundle and double–bundle (DB) reconstruction. Precise study on bundles anatomy, the exact number of attachments and knee flexion angle with an appropriate place of bundles and also choosing the best angle for the grafts are so important in successful reconstructing of the bundles. In this research, the general attempt was to assess anatomy and the act of the ACL is and bundles in Iranian population. Methods: We obtained twelve fresh-frozen cadaver knees (two females, ten males). The average age of them was 30 years; they were mostly between 27 and 34 years old. Initially, skin, muscles, and patellar and articular capsule were removed. Then, bundle attachments, knee movements in flexion angle, extension and stiffness of both bundles were evaluated. Thereafter, on 0, 30, 60, 90, 120, and 180° angle knee flexion the bundles degree stiffness evaluated in different directions. During the process, to measure bundles size, digital camera for photography, oblique for measuring the angles, and micrometer were utilized. From all next of kin written consent testimonial form was obtained. Results: In all knees, two bundles were identified as distinct. AMB attachment location in the anterior region observed as semi-lunate and in one case, it was rounded. In all cases, two bundles of full knee extension were paralleled, and the AMB was anterior to the PLB; with increasing flexion angle, femoral attachment location of AMB was in back direction and femoral attachment location of PLB moved toward the front direction. Two bundles were in the most amount of cross state, which the angle was 90°. From the stiffness point of view in all 6 samples, the PLB had the most tension in extension state, and the AMB had the most tension in 120° flexion. Conclusion: In the current study, we realized that the ACL is a DB ligament in Iranian population. The AMB in full extension has the least stiffness and in 90° flexion has the most; the PLB also in full knee extension and in 160° flexion has the most and least stiffness, respectively.

Moghaddam, Ahmad Bagheri; Torkaman, Ali

2013-01-01

298

A Comparison of Functional Outcomes After Metallic and Bioabsorbable Interference Screw Fixations in Arthroscopic ACL Reconstructions  

PubMed Central

Introduction: Anterior Cruciate Ligament (ACL) is as one of the most frequently injured ligaments in the modern contact sports scenario. Graft fixations can be achieved during anterior cruciate ligament (ACL) reconstructions by using either bioabsorbable screws or metal screws. The objective of this study was to compare the functional outcomes after bioabsorbable and metallic interference screw fixations in arthroscopic anterior cruciate ligament reconstructions done by using hamstring grafts. Materials and Methods: This was a prospective, randomized study. Patients in Group 1 received bioabsorbable interference screws and patients in Group 2 received metallic interference screws. Arthroscopic assisted, anterior cruciate ligament reconstructions with the use of hamstring grafts which were fixed proximally with endobuttons and distally with bioabsorbable or metallic interference screws, were undertaken. Progress in functional outcomes was assessed by using Mann Whitney U- test. Functional outcomes in the two groups were compared by using independent t-test. Observation and Results: In each group, there were statistically significant improvements in functional outcomes over successive follow-ups, which were seen on basis on Mann-Whitney U-test. The comparison of functional outcomes between the two groups, done by using independent t-test, showed no statistically significant differences between the two groups at 3 months, 6 months and 1 year of follow-up. p-value <0.05 was considered to be significant in our study. Conclusion: In our prospective study of comparison of functional outcomes between bioabsorbable and metallic interference screws in arthroscopic anterior cruciate ligament reconstuctions, which were evaluated by using Tegner activity scale and Lysholm knee scoring scale for a period of 1 year, no statistically significant difference was found. However, further authentication is required by doing long term studies.

Rai, Deepak K; Kannampilly, Antony J

2014-01-01

299

[Isokinetic torque of quadriceps in patients with untreated anterior cruciate ligament injury of the knee joint].  

PubMed

In order to study the role of muscle strength in patients with untreated anterior cruciate ligament (ACL) injury of the knee joint, the torque of the quadriceps was isokinetically measured during concentric contraction (CC) and passive eccentric contraction (PEC). The results were compared with those in normal individuals and sports players. Ninety patients with untreated ACL injury were subjected for the study. There were 50 men and 40 women. The normal group consisted of 20 students and the sports player group consisted of 20 soccer players. The peak torque and the torque at 30 degrees flexion of the quadriceps were isokinetically measured during CC and PEC by using a BIODEX machine. Results: In patients with ACL injury, the peak torque was smaller in the injured side as compared with the uninjured side. At the same angle velocity, decrease of PEC in the injured side was larger than that of CC. These results were compared with the normal group and the sports player group. There was significant difference in the peak torque per body weight among each groups. But, the torque per body weight at 30 degrees flexion was almost consistent in these three groups. Discussion: A considerable quadriceps atrophy occurs following ACL injury. In our experience, patients with functional absence of ACL are much more difficult to return to vigorous sports which require explosive eccentric contraction than to return to endurance sports which require repetitive concentric contractile efforts of the quadriceps. In the present study, decrease of the passive eccentric contraction in the injured side was more pronounced than that of the concentric contraction. From these results, the significantly decreased passive eccentric torque in the patients with untreated ACL injury can be a factor to cause instability of the knee joint in active daily life as well as in sports activities. PMID:8409643

Ikeda, H

1993-09-01

300

Cellular and extracellular matrix changes in anterior cruciate ligaments during human knee aging and osteoarthritis.  

PubMed

INTRODUCTION: Anterior cruciate ligament (ACL) degeneration is observed in most osteoarthritis (OA)-affected knee joints. However, the specific spatial and temporal relations of these changes and their association with extracellular matrix (ECM) degeneration are not well understood. The objective of this study was to characterize the patterns and relations of aging-related and OA-associated changes in ACL cells and the ECM. METHODS: Human knee joints from 80 donors (age 23 through 94) were obtained at autopsy. ACL degeneration was assessed histologically by using a quantitative scoring system. Tissue sections were analyzed for cell density, cell organization, ECM components, ECM-degrading enzymes and markers of differentiation, proliferation, and stem cells. RESULTS: Total cell number in normal ACL decreased with aging but increased in degenerated ACL, because of the formation of perivascular cell aggregates and islands of chondrocyte-like cells. Matrix metalloproteinase (MMP)-1, -3, and -13 expression was reduced in aging ACL but increased in degenerated ACL, mainly in the chondrocyte-like cells. Collagen I was expressed throughout normal and degenerated ACL. Collagen II and X were detected only in the areas with chondroid metaplasia, which also expressed collagen III. Sox9, Runt-related transcription factor 2 (Runx2), and scleraxis expression was increased in the chondrocyte-like cells in degenerated ACL. Alpha-smooth muscle actin (?-SMA), a marker of myofibroblasts and the progenitor cell marker STRO-1, decreased with aging in normal ACL. In degenerated ACL, the new cell aggregates were positive for ?-SMA and STRO-1. CONCLUSIONS: ACL aging is characterized by reduced cell density and activation. In contrast, ACL degeneration is associated with cell recruitment or proliferation, including progenitor cells or myofibroblasts. Abnormally differentiated chondrocyte-like cell aggregates in degenerated ACL produce abnormal ECM and may predispose to mechanical failure. PMID:23406989

Hasegawa, Akihiko; Nakahara, Hiroyuki; Kinoshita, Mitsuo; Asahara, Hiroshi; Koziol, James; Lotz, Martin K

2013-02-14

301

Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors  

PubMed Central

AIM: To evaluate the effect of the application of plasma rich in growth factors (PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament (ACL) tears. METHODS: A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability. Patients with knee instability requiring revision surgery for remnant ACL were selected. PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated. RESULTS: A total of 19 patients were reviewed. Three had a Tegner activity level of 10 and the remaining 16 level 9. The time between the injury and the time of surgery was 5.78 wk (SD 1.57). In total, 81.75% (16/19) returned to the same pre-injury level of sport activity (Tegner 9-10). 17 males and 2 females were treated. The rate of associated injury was 68.42% meniscal lesions and 26.31% cartilage lesions. The KT-1000 values were normalized in all operated cases. One patient was not able to return to sport due to the extent of their cartilage lesions. The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk (SD 1.44) while the 3 patients with Tegner activity level 10 did so in 12.33 wk (SD 1.11). CONCLUSION: With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre- injury level in professional football players.

Seijas, Roberto; Ares, Oscar; Cusco, Xavier; Alvarez, Pedro; Steinbacher, Gilbert; Cugat, Ramon

2014-01-01

302

Factors influencing the implementation of anterior cruciate ligament injury prevention strategies by girls soccer coaches.  

PubMed

Women are 3 times more likely to injure their anterior cruciate ligament (ACL) while playing soccer than men. ACL injury prevention programs (IPPs) involving stretching and strengthening drills can reduce the incidence of ACL injury when incorporated into routine training. The rate of implementation among coaches is largely unknown. The purpose of this study was to determine the rate of implementation of ACL IPP, to identify factors that influence implementation, and to acquire information to assist in design dissemination and implementation strategies. Study subjects were coaches of woman soccer players aged 11-22 years in Utah (n = 756). Data were gathered using a Web-based survey followed by a qualitative study in which "best practice coaches"-coaches who met criteria for successful implementation of ACL IPP-were interviewed via telephone. A minority of survey respondents, 19.8% (27/136), have implemented ACL IPP. Factors associated with successful implementation include length of coaching experience and presence of additional support staff such as a strength and conditioning coach or athletic trainer. Best practice coaches (14/136) unanimously agreed on the following: (a) there are performance-enhancing benefits of ACL IPP, (b) education on ACL injury prevention should be required for licensure, and (c) dissemination and implementation will require soccer associations to enact policies that require IPPs. In conclusion, a minority of girls soccer coaches have implemented ACL IPP and those that have do so because they believe that prevention improves performance and that soccer organizations should enact policies requiring ACL injury prevention education and implementation. Efforts to implement ACL IPP should be driven by soccer organizations, emphasize performance-enhancing benefits, and engage additional coaching staff. PMID:23287828

Joy, Elizabeth A; Taylor, John R; Novak, Melissa A; Chen, Michael; Fink, Barbara P; Porucznik, Christina A

2013-08-01

303

Clinical Results Comparing Transtibial Technique and Outside in Technique in Single Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

Purpose To compare the clinical results of single-bundle anterior cruciate ligament (ACL) reconstruction using the conventional transtibial technique and the anatomical outside-in technique for femoral tunneling. Materials and Methods From 2007 to 2011, 89 patients who received ACL reconstruction were followed for ?1 year were enrolled in the study. The conventional transtibial technique was used in 41 patients and the outside-in technique, in 48 patients. Femoral tunnel angle measurement and three-dimensional computed tomography (3D CT) were used for radiologic assessment of the location of femoral tunnel and Lysholm score and other tests were used for clinical assessment. Results Both techniques did not reveal statistical differences in the clinical assessment. However, in International Knee Documentation Committee subjective knee evaluation, the sum of two questionnaire items regarding instability showed a statistically significant difference (p=0.01). In the pivot shift test, the anatomical outside-in technique showed outstanding rotational stability over the transtibial technique (p=0.04). The mean femoral tunnel inclination in coronal plane were 69.2° and 30.3°, respectively, for both techniques, and 21.6° and 50.8°, respectively in sagittal plane, showing statistically significant differences on simple radiography (p=0.04, 0.05). A 3D CT was performed in 17 patients with the conventional transtibial technique and 25 patients with the outside-in technique. Coefficients of variation were 0.33 and 0.13, respectively, from dorsal border of the condyle and 0.67 and 0.24, respectively, from the roof of intercondylar notch. Conclusions Femoral tunnels created with the outside-in technique have superior knee joint rotational stability compare to the transtibial technique. Therefore, the outside-in technique could be considered as a valuable technique in single-bundle ACL reconstruction.

Seo, Seung Suk; Kim, Jeon Gyo; Jin, Sung Yub

2013-01-01

304

Knee moments of anterior cruciate ligament reconstructed and control participants during normal and inclined walking  

PubMed Central

Objectives Prior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups. Participants 12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes. Results No significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12?Nm/kg?m) when compared with those with isolated ACLR (5 participants, 0.1±0.057?Nm/kg?m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait. Conclusions Participants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone.

Varma, Raghav K; Duffell, Lynsey D; Nathwani, Dinesh; McGregor, Alison H

2014-01-01

305

Proteomic Differences between Male and Female Anterior Cruciate Ligament and Patellar Tendon  

PubMed Central

The risk of anterior cruciate ligament (ACL) injury and re-injury is greater for women than men. Among other factors, compositional differences may play a role in this differential risk. Patellar tendon (PT) autografts are commonly used during reconstruction. The aim of the study was to compare protein expression in male and female ACL and PT. We hypothesized that there would be differences in key structural components between PT and ACL, and that components of the proteome critical for response to mechanical loading and response to injury would demonstrate significant differences between male and female. Two-dimensional liquid chromatography-tandem mass spectrometry and a label-free quantitative approach was used to identify proteomic differences between male and female PT and ACL. ACL contained less type I and more type III collagen than PT. There were tissue-specific differences in expression of proteoglycans, and ACL was enriched in elastin, tenascin C and X, cartilage oligomeric matrix protein, thrombospondin 4 and periostin. Between male and female donors, alcohol dehydrogenase 1B and complement component 9 were enriched in female compared to male. Myocilin was the major protein enriched in males compared to females. Important compositional differences between PT and ACL were identified, and we identified differences in pathways related to extracellular matrix regulation, complement, apoptosis, metabolism of advanced glycation end-products and response to mechanical loading between males and females. Identification of proteomic differences between male and female PT and ACL has identified novel pathways which may lead to improved understanding of differential ACL injury and re-injury risk between males and females.

Little, Dianne; Thompson, J. Will; Dubois, Laura G.; Ruch, David S.; Moseley, M. Arthur; Guilak, Farshid

2014-01-01

306

Proprioceptive deficits of the lower limb following anterior cruciate ligament deficiency affect whole body steering control.  

PubMed

The role of lower limb proprioception in the steering control of locomotion is still unclear. The purpose of the current study was to determine whether steering control is altered in individuals with reduced lower limb proprioception. Anterior cruciate ligament deficiency (ACLD) results in a decrease in proprioceptive information from the injured knee joint (Barrack et al. 1989). Therefore the whole body kinematics were recorded for eight unilateral ACLD individuals and eight CONTROL individuals during the descent of a 20 degrees incline ramp followed by either a redirection using a side or cross cutting maneuver or a continuation straight ahead. Onset of head and trunk yaw, mediolateral displacement of a weighted center of mass (COM(HT)) and mediolateral displacement of the swing foot were analyzed to evaluate differences in the steering control. Timing analyses revealed that ACLD individuals delayed the reorientation of body segments compared to CONTROL individuals. In addition, ACLD did not use a typical steering synergy where the head leads whole body reorientation; rather ACLD individuals reoriented the head, trunk and COM(HT) in the new direction at the same time. These results suggest that when lower limb proprioceptive information is reduced, the central nervous system (CNS) may delay whole body reorientation to the new travel direction, perhaps in order to integrate existing sensory information (vision, vestibular and proprioception) with the reduced information from the injured knee joint. This control strategy is maintained when visual information is present or reduced in a low light environment. Additionally, the CNS may move the head and trunk segments as, effectively, one segment to decrease the number of degrees of freedom that must be controlled and increase whole body stability during the turning task. PMID:17704908

Reed-Jones, Rebecca J; Vallis, Lori Ann

2007-09-01

307

The Utility of Claims Data for Infection Surveillance following Anterior Cruciate Ligament Reconstruction.  

PubMed

Objective.?To explore the feasibility of identifying anterior cruciate ligament (ACL) allograft implantations and infections using claims. Design.?Retrospective cohort study. Methods.?We identified ACL reconstructions using procedure codes at 6 health plans from 2000 to 2008. We then identified potential infections using claims-based indicators of infection, including diagnoses, procedures, antibiotic dispensings, specialty consultations, emergency department visits, and hospitalizations. Patients' medical records were reviewed to determine graft type, validate infection status, and calculate sensitivity and positive predictive value (PPV) for indicators of ACL allografts and infections. Results.?A total of 11,778 patients with codes for ACL reconstruction were identified. After chart review, PPV for ACL reconstruction was 96% (95% confidence interval [CI], 94%-97%). Of the confirmed ACL reconstructions, 39% (95% CI, 35%-42%) used allograft tissues. The deep infection rate after ACL reconstruction was 1.0% (95% CI, 0.7%-1.4%). The odds ratio of infection for allografts versus autografts was 0.41 (95% CI, 0.19-0.78). Sensitivity of individual claims-based indicators for deep infection after ACL reconstruction ranged from 0% to 75% and PPV from 0% to 100%. Claims-based infection indicators could be combined to enhance sensitivity or PPV but not both. Conclusions.?While claims data accurately identify ACL reconstructions, they poorly distinguish between allografts and autografts and identify infections with variable accuracy. Claims data could be useful to monitor infection trends after ACL reconstruction, with different algorithms optimized for different surveillance goals. PMID:24799641

Murphy, Michael V; Du, Dongyi Tony; Hua, Wei; Cortez, Karoll J; Butler, Melissa G; Davis, Robert L; Decoster, Thomas; Johnson, Laura; Li, Lingling; Nakasato, Cynthia; Nordin, James D; Ramesh, Mayur; Schum, Michael; Von Worley, Ann; Zinderman, Craig; Platt, Richard; Klompas, Michael

2014-06-01

308

Retear of anterior cruciate ligament grafts in female basketball players: a case series  

PubMed Central

Background Incidence of anterior cruciate ligament (ACL) injuries in young female basketball players is higher than that in male basketball players. Graft retears are more frequent with the increasing number of ACL reconstructions. The present study aimed to examine the incidence of retears in competitive female basketball players. Methods Sixty-four female basketball players (aged 12 to 29 years) who underwent primary anatomic double-bundle ACL reconstruction using hamstring grafts participated in the study. We investigated incidence, mechanism, and patient characteristics of ACL graft retears. Mann-Whitney U test was used for statistical analysis, and the level of significance was determined at P < 0.05. Results Six patients suffered from ACL graft retear (9.4%). Mean duration between primary ACL reconstruction and incidence of retears was 11.7 months. However, there were no other postoperative graft ruptures after 24 months. Primary injury and retear mechanisms varied by patient. At six months after the primary ACL reconstruction surgery, mean quadriceps and hamstring strengths were 81% and 87%, respectively, indicating favorable recovery of muscle strength. However, preoperative quadriceps and hamstring strength in the retear group were 65% and 71%, respectively. In particular, preoperative quadriceps strength in the retear group demonstrated a lower value than that in the uninjured group (P < 0.05). Conclusions We observed a high incidence of ACL graft retears in competitive female basketball players, as previously reported. Considering the timing of graft retear occurrences, an early return to playing basketball should be avoided following ACL reconstruction. Closer attention should be paid to player preoperative condition, as well as muscle strength and postoperative status.

2010-01-01

309

Pilot study of female high school basketball players' anterior cruciate ligament injury knowledge, attitudes, and practices.  

PubMed

An anterior cruciate ligament (ACL) injury prevention program was evaluated. One hundred and thirteen female high school varsity and junior varsity basketball players and 12 coaches participated in an 8-week educational and skills program. Demographic and injury history data were collected. At pre-intervention and at the end of season, knowledge, attitudes, and practices about ACL risk and injury prevention were assessed via questionnaires, and frequency of two-footed landings were videotaped during games. Univariate statistics described the sample. Paired t-tests evaluated the program's impact. Cronbach's alpha, correlations, and kappa statistics assessed the validity and reliability of questionnaires and video analysis. Of the 113 players, 74 completed the study. The players' mean age was 16.25 years (SD=1.07; range=14.2-18.8). Baseline knowledge score was 57.2%, practice 58.4%, and attitude 73.5%. The mean baseline knowledge score of the 12 coaches (mean age=40.8 years; SD=10.3; range=26.9-56.3) was 68.7%. Players' knowledge about ACL injury prevention improved (t=2.57; P<0.01). No changes in attitudes toward injury prevention were found (t(diff)=1.88; P<0.06). Inter-rater reliability of two-footed landings observed was acceptable (kappa=0.72). Videotape analyses revealed a 5.5% increase in landing performance (t(diff)=9.6; P<0.0001). The program increased knowledge about ACL injury risk and improved player's landing skills. PMID:18627558

Iversen, M D; Friden, C

2009-08-01

310

A multi-scale structural study of the porcine anterior cruciate ligament tibial enthesis.  

PubMed

Like the human anterior cruciate ligament (ACL), the porcine ACL also has a double bundle structure and several biomechanical studies using this model have been carried out to show the differential effect of these two bundles on macro-level knee joint function. It is hypothesised that if the different bundles of the porcine ACL are mechanically distinct in function, then a multi-scale anatomical characterisation of their individual enthesis will also reveal significant differences in structure between the bundles. Twenty-two porcine knee joints were cleared of their musculature to expose the intact ACL following which ligament-bone samples were obtained. The samples were fixed in formalin followed by decalcification with formic acid. Thin sections containing the ligament insertion into the tibia were then obtained by cryosectioning and analysed using differential interference contrast (DIC) optical microscopy and scanning electron microscopy (SEM). At the micro-level, the anteromedial (AM) bundle insertion at the tibia displayed a significant deep-rooted interdigitation into bone, while for the posterolateral (PL) bundle the fibre insertions were less distributed and more focal. Three sub-types of enthesis were identified in the ACL and related to (i) bundle type, (ii) positional aspect within the insertion, and (iii) specific bundle function. At the nano-level the fibrils of the AM bundle were significantly larger than those in the PL bundle. The modes by which the AM and PL fibrils merged with the bone matrix fibrils were significantly different. A biomechanical interpretation of the data suggests that the porcine ACL enthesis is a specialized, functionally graded structural continuum, adapted at the micro-to-nano scales to serve joint function at the macro level. PMID:24697495

Zhao, Lei; Thambyah, Ashvin; Broom, Neil D

2014-06-01

311

Classification of functional recovery of anterior cruciate ligament copers, non-copers, and adapters  

PubMed Central

Objectives (a) To identify whether differences exist in the pattern of recovery with respect to functional outcomes for acutely ruptured anterior cruciate ligament deficient (ACLD) copers, adapters, and non?copers. (b) To identify clinically relevant outcomes that could distinguish between three functional subgroups. Methods A longitudinal study was used to measure gait variables and distance hop at regular intervals after injury using a digital camcorder and computer for quantitative analysis. A sample of 63 ACLD subjects entered the study; 42 subjects were measured at least three times. At 12–36?months after injury, subjects were classified as functional copers, adapters, or non?copers on the basis of which of their preinjury activities they had resumed. To determine the pattern of recovery, repeated measurements were analysed using a least squares fit of the data. Results 17% of ACLD subjects were classified as functional copers, 45% as adapters, and 38% as non?copers. Only 5% of those who participated in high demand activities before injury returned to them. ACLD copers had recovered above the control mean for all gait variables by 40?days after the injury. Hopping distance did not recover to the control mean. Non?copers struggled to recover to control limits and remained borderline for all the gait variables. Conclusions Distinctive patterns of functional recovery for three subgroups of ACLD subjects have been identified. Gait variables and activity level before injury were the most useful variables for distinguishing between the subgroups. If potential for recovery is identified early after injury, then appropriate treatment can be given.

Button, K; van Deursen, R; Price, P

2006-01-01

312

In vitro biomechanical testing of anterior cruciate ligament reconstruction: traditional versus physiologically relevant load analysis.  

PubMed

Various anterior cruciate ligament (ACL) graft-fixation devices exist. In this in vitro study a comparison of biomechanical characteristics of the cross-pin and button type fixation devices under practical rehabilitation loads was done. Forty bovine knees and hoof extensor tendons were harvested. After disarticulation, the femoral end of an ACL was prepared with either fixation, using the extensor tendon as graft. The mechanical test was either a single load to failure or load to failure after cycling loads. Twenty specimens were loaded to failure at a rate of 1mm/s, remaining specimens were cycled between 50 and 250 N for 1000 cycles then failure tested in a similar manner. Results show that both forms of fixation are able to withstand loads that exceed those observed in performing functional activities. Activity-specific stiffness (loads comparable to walking, jogging and stair descent) was lower than linear stiffness for both endobutton and cross-pin, without prior cycling. After cycling, activity-specific stiffness increased to linear stiffness values for the cross-pin for all activities. Thus, suggesting that the cross-pin provides a more rigid fixation after initial implantation over a wider range of activities, which would theoretically permit a more aggressive rehabilitation protocol and possibly an earlier return to regular activity. In contrast, activity-specific stiffness increased above linear stiffness values for the endobutton only under heavier loads (jogging and stair descent). Dynamic stiffness was higher and displacement lower for cross-pin throughout the cycle test. These results indicate, in ACL reconstruction, that graft complex stiffness should be considered at relevant loads only. PMID:20570155

Trump, Mark; Palathinkal, Darren M; Beaupre, Lauren; Otto, Dave; Leung, Paul; Amirfazli, A

2011-06-01

313

Effects of an anterior cruciate ligament injury prevention program on performance in adolescent female soccer players.  

PubMed

Female soccer players are three times more likely to suffer a non-contact anterior cruciate ligament (ACL) tear compared with male soccer players. Several ACL injury prevention programs have been developed and are used to reduce injury risk. However, to date there is limited information on how such programs affect physical performance. The aim of this randomized controlled study was to investigate the effects of the Prevent Injury Enhance Performance (PEP) program in adolescent female soccer players. Four soccer teams were randomly assigned to an intervention (PEP) or control (CON) group and assessed at baseline, 6 weeks, and 12 weeks on linear sprinting, countermovement jump (CMJ), and two agility tests. A mixed model factorial ANOVA with repeated measures was used to assess for treatment effects on the dependent variables. Improvements in 27.3 and 36.6 m sprint times (<0.10 s) were evident during the first 6 weeks for PEP, but reverted back to baseline values by 12 weeks; there were no changes for 9.1 or 18.2 m sprint times in either group. There was no change in the CMJ height for PEP; however, there was a decrement at 6 and 12 weeks compared with baseline in CON. Performance on the Illinois and pro-agility tests declined in both groups. Our findings demonstrate that improvements in linear sprint performance were small and transient in adolescent female soccer players, and that there was no benefit of the PEP program on CMJ or agility performance. ACL injury prevention programs designed as a structured warm-up routine seem to lack the necessary stimulus to enhance athletic performance. PMID:19558381

Vescovi, J D; VanHeest, J L

2010-06-01

314

Isolation and characterization of human anterior cruciate ligament-derived vascular stem cells.  

PubMed

The anterior cruciate ligament (ACL) usually fails to heal after rupture mainly due to the inability of the cells within the ACL tissue to establish an adequate healing process, making graft reconstruction surgery a necessity. However, some reports have shown that there is a healing potential of ACL with primary suture repair. Although some reports showed the existence of mesenchymal stem cell-like cells in human ACL tissues, their origin still remains unclear. Recently, blood vessels have been reported to represent a rich supply of stem/progenitor cells with a characteristic expression of CD34 and CD146. In this study, we attempted to validate the hypothesis that CD34- and CD146-expressing vascular cells exist in hACL tissues, have a potential for multi-lineage differentiation, and are recruited to the rupture site to participate in the intrinsic healing of injured ACL. Immunohistochemistry and flow cytometry analysis of hACL tissues demonstrated that it contains significantly more CD34 and CD146-positive cells in the ACL ruptured site compared with the noninjured midsubstance. CD34+CD45- cells isolated from ACL ruptured site showed higher expansionary potentials than CD146+CD45- and CD34-CD146-CD45- cells, and displayed higher differentiation potentials into osteogenic, adipogenic, and angiogenic lineages than the other cell populations. Immunohistochemistry of fetal and adult hACL tissues demonstrated a higher number of CD34 and CD146-positive cells in the ACL septum region compared with the midsubstance. In conclusion, our findings suggest that the ACL septum region contains a population of vascular-derived stem cells that may contribute to ligament regeneration and repair at the site of rupture. PMID:21732814

Matsumoto, Tomoyuki; Ingham, Sheila M; Mifune, Yutaka; Osawa, Aki; Logar, Alison; Usas, Arvydas; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H; Huard, Johnny

2012-04-10

315

Isolation and Characterization of Human Anterior Cruciate Ligament-Derived Vascular Stem Cells  

PubMed Central

The anterior cruciate ligament (ACL) usually fails to heal after rupture mainly due to the inability of the cells within the ACL tissue to establish an adequate healing process, making graft reconstruction surgery a necessity. However, some reports have shown that there is a healing potential of ACL with primary suture repair. Although some reports showed the existence of mesenchymal stem cell-like cells in human ACL tissues, their origin still remains unclear. Recently, blood vessels have been reported to represent a rich supply of stem/progenitor cells with a characteristic expression of CD34 and CD146. In this study, we attempted to validate the hypothesis that CD34- and CD146-expressing vascular cells exist in hACL tissues, have a potential for multi-lineage differentiation, and are recruited to the rupture site to participate in the intrinsic healing of injured ACL. Immunohistochemistry and flow cytometry analysis of hACL tissues demonstrated that it contains significantly more CD34 and CD146-positive cells in the ACL ruptured site compared with the noninjured midsubstance. CD34+CD45? cells isolated from ACL ruptured site showed higher expansionary potentials than CD146+CD45? and CD34?CD146?CD45? cells, and displayed higher differentiation potentials into osteogenic, adipogenic, and angiogenic lineages than the other cell populations. Immunohistochemistry of fetal and adult hACL tissues demonstrated a higher number of CD34 and CD146-positive cells in the ACL septum region compared with the midsubstance. In conclusion, our findings suggest that the ACL septum region contains a population of vascular-derived stem cells that may contribute to ligament regeneration and repair at the site of rupture.

Matsumoto, Tomoyuki; Ingham, Sheila M.; Mifune, Yutaka; Osawa, Aki; Logar, Alison; Usas, Arvydas; Kuroda, Ryosuke; Kurosaka, Masahiro; Fu, Freddie H.

2012-01-01

316

Peripheral nerve blockade as an exclusive approach to obturator nerve block in anterior cruciate ligament reconstructive surgery  

PubMed Central

Background Obturator nerve block plays an additive role on the quality of analgesia for knee surgery. Since the use of dual guidance increases the success rate of nerve blocks, we investigated the feasibility of performing anterior cruciate ligament reconstruction under dual-guided blockade of obturator with femoral and sciatic nerves. Furthermore, we propose a novel method for the assessment of obturator nerve block. Methods Fifty-seven patients undergoing anterior cruciate ligament repair were studied. Neurostimulating needles were guided out-of-plane by ultrasound. To induce the obturator nerve block, 10 ml of ropivacaine 0.5% were injected after eliciting contractions of adductor longus, brevis and magnus followed by block assessment for 30 minutes by examining the patient lift and left down the leg. Results The sonographic recognition of obturator nerve was easy and quick in all cases. Time for applying the block was 119.9 ± 79.2 sec. Assessing this block with lifting-leaving down the leg gave satisfactory results in 24.0 ± 5.07 min. After performing femoral-sciatic blocks, the inflation of tourniquet resulted in VAS score of > 0 in 2/57 patients and operation in 12/57. Total dose of fentanyl was 120.1 ± 64.6 µg and of midazolam 1.86 ± 0.8 mg. In 6 patients propofol was administered for sedation and 1 of them required ventilation with laryngeal mask airway, converting the anesthesia technique to general anesthesia. Conclusions Our data suggest that anterior cruciate ligament reconstruction can be performed under obturator-femoral-sciatic blocks. Identification of obturator nerve with ultrasound is easy and the block can be assessed by observing how the patient lifts and leaves down the leg.

Simeoforidou, Marina; Basdekis, George; Tsiaka, Katerina; Chantzi, Eleni; Vretzakis, George

2013-01-01

317

The mid- to long-term results of the anterior cruciate ligament reconstruction with hamstring tendons using Transfix technique.  

PubMed

In this study, mid to long-term results of anterior cruciate ligament reconstruction with hamstring tendons and Transfix technique were evaluated. Anterior cruciate ligament (ACL) reconstruction with four-strand hamstring tendon was performed with Transfix technique on 271 (198 males, 73 females; mean age 25.7; 17-52) patients with anterior cruciate ligament ruptures. The patients were followed up with clinical examination, Lysholm and Tegner activity scales, IKDC scoring system, KT-1000 test and radiological examination. The mean follow-up period was 82 (48-100) months; 204 (75%) patients had no subjective complaints. According to the KT-1000 test, only 14 (5%) patients had more than 5 mm laxity postoperatively, whereas, 161 (59%) patients had more than 5 mm laxity preoperatively. In addition to this, only 19 (7%) patients had Lysholm scores less than 80 postoperatively, whereas 154 (57%) patients scored less than 80 preoperatively. When compared with Tegner activity scale, 189 (70%) patients scored<6 preoperatively and only 24 (8%) postoperatively; 78 (29%) patients scored D preoperatively and only 5 (2%) patients scored D postoperatively on the basis of the IKDC scoring system. Our functional results were found to be satisfactory in more than 90% of patients. Commonly seen problems in ACL reconstruction such as inaccurate graft placement and tunnel widening were found to be consistent with the values in relevant literature. However, we demonstrated that the functional results and the stability of the knee were not related with tunnel widening. This study concludes that the reconstruction of ACL with hamstring tendons and the Transfix technique is reasonably successful, safe and causes low morbidity. Furthermore, we believe that proper graft preparation, accurate tunnel placement, notch-plasty, fixation and rehabilitation program are all as important as the choice of graft and fixation material. PMID:17503019

Asik, Mehmet; Sen, Cengiz; Tuncay, Ibrahim; Erdil, Mehmet; Avci, Cem; Taser, Omer F

2007-08-01

318

Evaluation of isokinetic and isometric strength measures for monitoring muscle function recovery after anterior cruciate ligament reconstruction.  

PubMed

Knezevic, OM, Mirkov, DM, Kadija, M, Milovanovic, D, and Jaric, S. Evaluation of isokinetic and isometric strength measures for monitoring muscle function recovery after anterior cruciate ligament reconstruction. J Strength Cond Res 28(6): 1722-1731, 2014-Although various strength tests and their outcome measures have been proposed for anterior cruciate ligament (ACL) reconstruction (ACLR), their measurement properties still remain relatively underexplored. The aim of this study was to investigate the longitudinal construct validity of the standard isokinetic (IKT) and isometric test (IMT), and of the IMT of alternating consecutive maximal contractions (ACMC). In addition, the concurrent validity of ACMC was assessed and compared with the validity of IMT. The strength of quadriceps and hamstrings in 20 male athletes with an anterior cruciate ligament (ACL) injury were assessed before ACLR, 4 and 6 months after ACLR, by means of IMT, ACMC, and IKT performed at 60 and 180°·s. Significant between-session differences in muscle strength variables were found in the involved quadriceps (F > 6.5; p ? 0.05), but not in the uninvolved leg (F < 2.5; p > 0.05). Coefficients of variations in the uninvolved leg (all below 13.5%) were lower than the involved leg (11.7-22.1%). Intraclass correlation coefficients were moderate-to-high for the uninvolved leg and low-to-high for quadriceps of the involved leg. The concurrent validity of ACMC with respect to the IKT (r = 0.57-0.92; p ? 0.05) was comparable with the validity of IMT (r = 0.52-0.87; p ? 0.05). We conclude that the explored longitudinal construct validity of most of the evaluated variables could be sufficiently sensitive to detect the effects of the applied rehabilitation procedures. In addition, the obtained sensitivity and concurrent validity and the potential advantages of ACMC over IMT, all suggest that ACMC could be a particularly promising method for routine testing of neuromuscular function after ACLR. PMID:24169472

Knezevic, Olivera M; Mirkov, Dragan M; Kadija, Marko; Milovanovic, Darko; Jaric, Slobodan

2014-06-01

319

A tissue engineering approach to anterior cruciate ligament regeneration using novel shaped capillary channel polymer fibers  

NASA Astrophysics Data System (ADS)

Ruptures of the anterior cruciate ligament (ACL) are the most frequent of injuries to the knee due to its role in preventing anterior translation of the tibia. It is estimated that as many as 200,000 Americans per year will suffer from a ruptured ACL, resulting in management costs on the order of 5 billion dollars. Without treatment these patients are unable to return to normal activity, as a consequence of the joint instability found within the ACL deficient knee. Over the last thirty years, a variety of non-degradable, synthetic fibers have been evaluated for their use in ACL reconstruction; however, a widely accepted prosthesis has been unattainable due to differences in mechanical properties of the synthetic graft relative to the native tissue. Tissue engineering is an interdisciplinary field charged with the task of developing therapeutic solutions for tissue and organ failure by enhancing the natural wound healing process through the use of cellular transplants, biomaterials, and the delivery of bioactive molecules. The capillary channel polymer (CC-P) fibers used in this research were fabricated by melt extrusion from polyethylene terephthalate and polybutylene terephthalate. These fibers possess aligned micrometer scale surface channels that may serve as physical templates for tissue growth and regeneration. This inherent surface topography offers a unique and industrially viable approach for cellular contact guidance on three dimensional constructs. In this fundamental research the ability of these fiber channels to support the adhesion, alignment, and organization of fibroblasts was demonstrated and found to be superior to round fiber controls. The results demonstrated greater uniformity of seeding and accelerated formation of multi-layered three-dimensional biomass for the CC-P fibers relative to those with a circular cross-section. Furthermore, the CC-P geometry induced nuclear elongation consistent with that observed in native ACL tissue. Through the application of uniaxial cyclic strain the mechanical properties of the cell seeded CC-P fiber scaffold systems were shown to improve via the induction of increased cellular proliferation and extracellular matrix synthesis. Finally, unlike many studies examining the effects of cyclic strain on cellular behavior, the CC-P fiber geometry displayed the ability to maintain cellular alignment in the presence of an applied uniaxial cyclic strain.

Sinclair, Kristofer D.

320

Proximal anterior cruciate ligament avulsion fracture in a skeletally immature athlete: a case report and method of physeal sparing repair.  

PubMed

Traumatic rupture of the anterior cruciate ligament (ACL) in adulthood is relatively common and surgical reconstruction is frequently required to allow return to high-level activities. There is growing evidence to suggest that ACL rupture in children is more common than previously thought and a poor outcome is associated with conservative management. The site of rupture in childhood is predominantly tibial avulsion, but mid-substance tears have also been reported. We report a case of a proximal ACL avulsion in an 11-year-old athlete and discuss a method of extra-physeal repair. There are very few previous reports of proximal avulsion fractures in skeletally immature patients. PMID:16937153

Edwards, M R; Terry, J; Gibbs, J; Bridle, S

2007-02-01

321

Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears  

PubMed Central

Background: Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors. Purpose: The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair. Study Design: Case series. Methods: Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness. Results: At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient. Conclusions: Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing.

Strickland, Justin P.; Fleckenstein, Cassie M.; Ducker, Al; Hasan, Samer S.

2010-01-01

322

Long term results of anterior cruciate ligament reconstruction with iliotibial tract: 6-, 13-, and 24-year longitudinal follow-up.  

PubMed

Many studies have reported successful outcomes less than 10 years after anterior cruciate ligament (ACL) reconstruction. However, longer-term outcomes have not been analyzed. We assessd outcomes 24 years after anterior cruciate ligament reconstruction with iliotibial tract and compared them with shorter-term results in the same patients. Between 1979 and 1981, 45 patients underwent combined intra- and extra-articular ACL reconstruction with iliotibial tract. Follow-up evaluations of these patients were performed at 6, 13, and 24 years after surgery, which included manual and instrumental laxity testing, functional assessments, and radiography. Twenty-six (60%) patients of the original ACL reconstruction cohort participated in all three follow-up assessments. Three patients had undergone meniscectomy prior to ACL reconstruction and 18 underwent meniscectomy together with ACL reconstruction. Eleven patients underwent subsequent meniscectomy. The mean Lysholm score was 96.2, 93.8, and 87.8 at 6-, 13-, and 24-year follow-up, respectively. A significant decrease in mean Lysholm score was found between 13- and 24-year follow-up. The mean KT-1000 side-to-side difference was 3.5 mm at 24-year follow-up. Overall knee laxity did not change significantly during the follow-up period. At 24-year follow-up, 17 (71%) patients had moderate or severe degenerative changes on radiographs although about 50% of the patients participated in regular sports activities and no patient required regular clinical intervention. PMID:16845548

Yamaguchi, Satoshi; Sasho, Takahisa; Tsuchiya, Akihiro; Wada, Yuichi; Moriya, Hideshige

2006-11-01

323

Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women.  

PubMed

Reconstruction of the anterior cruciate ligament using a hamstring tendon autograft has often been recommended for female athletes. We compared the results of acute, isolated, intraarticular anterior cruciate ligament reconstructions using quadruple-looped hamstring autografts in 39 female and 26 male patients. All reconstructions were performed by the same surgeon using a similar surgical technique and the same postoperative management. In each case, patients had Endobutton femoral fixation and either post or button fixation for the tibial side. The average follow-up was 40.9 months for women and 39.0 months for men. Objective analysis of results included examination for the presence of effusion and crepitus, Lachman and pivot shift testing, and KT-1000 arthrometer testing for side-to-side differences. Subjective analysis consisted of a 15-item visual analog scale completed by patients postoperatively, and pre- and postoperative Tegner and Lysholm scores. The clinical failure rate was 23% (9 of 39) for the female patients and 4% (1 of 26) for the male patients, which was statistically significant. There was also a trend toward increased laxity in female patients. Subjectively, the women also reported a higher frequency and intensity of pain. Based on Tegner activity levels, more of the men returned to their preinjury level of activity than did the women. When compared with the male patients, female patients had a significantly higher failure rate after reconstruction. PMID:11101098

Noojin, F K; Barrett, G R; Hartzog, C W; Nash, C R

2000-01-01

324

Arthroscopic Double-Row Anterior Stabilization and Bankart Repair for the "High-Risk" Athlete  

PubMed Central

In addition to operative intervention for the patient with recurrent shoulder instability, current literature suggests that younger athletic patients unwilling to modify their activities may benefit from an early surgical shoulder stabilization procedure. Although open shoulder stabilization clearly has a role to play in some cases, we believe that further optimization of arthroscopic fixation techniques may allow us to continue to refine the indications for open stabilization. In particular, when an arthroscopic approach is used for capsulolabral repair in relatively high-risk groups, it may be beneficial to use a double-row repair technique. We describe our technique for shoulder stabilization through double-row capsulolabral repair of a soft-tissue Bankart lesion in the high-risk patient with shoulder instability or the patient with a small osseous Bankart lesion.

Moran, Cathal J.; Fabricant, Peter D.; Kang, Richard; Cordasco, Frank A.

2014-01-01

325

Ankle morbidity after autogenous Achilles tendon harvesting for anterior cruciate ligament reconstruction.  

PubMed

Although several alternative autografts with reduced morbidity of harvest site have been introduced, no donor site is free of morbidity concerns. The authors report on ankle status after autogenous Achilles tendon harvesting with a minimum 10-year follow-up. From October 1994 to October 1996, a consecutive series of 47 ankles underwent harvesting of the medial third or half of the ipsilateral autogenous Achilles tendon for primary anterior cruciate ligament reconstruction. Donor site statuses were evaluated using a modified Thermann's scale. Postoperative isokinetic muscle strength testing was performed, and magnetic resonance images of donor sites were available for selected patients. Thirty-three ankles in the 32 patients were followed for more than 10 years. There were 27 men (84%) and 5 women (16%) with a mean age of 31 years (range 16-52 years) at the time of surgery. The mean duration of follow-up was 12 years and 1 month (range 10 years and 5 months to 13 years and 4 months). Mean postoperative modified Thermann's scale score was 87 (range 45-95; SD 14.3). Twenty-five (76%) ankles achieved very good or good results. A slight decrease in calf circumference <1 cm was seen in the ten ankles, 1-2 cm in the four ankles. Nine ankles were mildly hypersensitive to meteorological changes. Peak torque of ankle plantar flexion was slightly lower on the index limb at both velocities in nine selected patients who carried out performance tests. However, there were no significant differences (5.2% at 30 degrees /s and 2.7% at 120 degrees /s, P = n.s. and P = n.s.). Of the 12 available follow-up magnetic resonance images, the average cross-sectional area of the remaining tendon was 82.01 mm(2) (range 69.05-107.35; SD 10.3), and their average thickness was 7.4 mm (range 6-10.35; SD 1.1). After a minimum 10-year follow-up, the harvesting of autogenous Achilles tendons was not found to significantly jeopardize ankle status. However, it also could not be independent of donor morbidity as an alternative. The level of evidence was retrospective level IV, as a therapeutic study. PMID:19214473

Seo, Jai Gon; Yoo, Jae Chul; Moon, Young Wan; Chang, Moon Jong; Kwon, Jong Won; Kim, Jong Hyun; Kim, Mu Hyun

2009-06-01

326

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction  

PubMed Central

Background The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively. Methods In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up. Results The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively. Conclusions To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.

2011-01-01

327

Ligament Stability Two to Six Years After Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft and Participation in Accelerated Rehabilitation Program  

Microsoft Academic Search

We studied patients who participated in our accelerated rehabilitation program after anterior cruciate ligament reconstructive surgery to determine if they showed signs of patellar tendon graft stretching. This program initiated in 1987 emphasizes early full hyperextension, early weightbearing as tolerated, and closed-chain functional activities with rapid return to sports when the patient has attained full range of motion, approximately 65%

K. Donald Shelbourne; Thomas E. Klootwyk; John H. Wilckens; Mark S. De Carlo

1995-01-01

328

Influence of bundle diameter and attachment point on kinematic behavior in double bundle anterior cruciate ligament reconstruction using computational model.  

PubMed

A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon's preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL) reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified. PMID:24516506

Kwon, Oh Soo; Purevsuren, Tserenchimed; Kim, Kyungsoo; Park, Won Man; Kwon, Tae-Kyu; Kim, Yoon Hyuk

2014-01-01

329

Retrospective Analysis of Arthroscopic Superior Labrum Anterior to Posterior Repair: Prognostic Factors Associated with Failure  

PubMed Central

Background. The purpose of this study was to report on any prognostic factors that had a significant effect on clinical outcomes following arthroscopic Type II SLAP repairs. Methods. Consecutive patients who underwent arthroscopic Type II SLAP repair were retrospectively identified and invited to return for follow-up examination and questionnaire. Statistical analysis was performed to determine associations between potential prognostic factors and failure of SLAP repair as defined by ASES of less than 50 and/or revision surgery. Results. Sixty-two patients with an average age of 36 ± 13 years met the study criteria with a mean followup of 3.3 years. There were statistically significant improvements in mean ASES score, forward elevation, and external rotation among patients. Significant associations were identified between ASES score less than 50 and age greater than 40 years; alcohol/tobacco use; coexisting diabetes; pain in the bicipital groove on examination; positive O'Brien's, Speed's, and/or Yergason's tests; and high levels of lifting required at work. There was a significant improvement in ASES at final followup. Conclusions. Patients younger than 20 and overhead throwers had significant associations with cases requiring revision surgery. The results from this study may be used to assist in patient selection for SLAP surgery.

Frank, Rachel M.; Nho, Shane J.; McGill, Kevin C.; Grumet, Robert C.; Cole, Brian J.; Verma, Nikhil N.; Romeo, Anthony A.

2013-01-01

330

Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial  

PubMed Central

Objective To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction. Design Extended follow-up of prospective randomised controlled trial. Setting Orthopaedic departments at two hospitals in Sweden. Participants 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. One patient was lost to five year follow-up. Intervention All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. Main outcome measure The main outcome was the change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score (KOOS4). Other outcomes included the absolute KOOS4 score, all five KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at five years. Results Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (seven between two and five years). The mean change in KOOS4 score from baseline to five years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points, 95% confidence interval ?8.5 to 4.5; P=0.54 after adjustment for baseline score). At five years, no significant between group differences were seen in KOOS4 (P=0.45), any of the KOOS subscales (P?0.12), SF-36 (P?0.34), Tegner activity scale (P=0.74), or incident radiographic osteoarthritis of the index knee (P=0.17). No between group differences were seen in the number of knees having meniscus surgery (P=0.48) or in a time to event analysis of the proportion of meniscuses operated on (P=0.77). The results were similar when analysed by treatment actually received. Conclusion In this first high quality randomised controlled trial with minimal loss to follow-up, a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear. Trial registration Current Controlled Trials ISRCTN84752559.

2013-01-01

331

Day case arthroscopy and arthroscopic surgery of the knee.  

PubMed

A Day Case Unit was opened at Wexham Park Hospital in October 1985 and this paper describes the first year's experience in arthroscopy and arthroscopic surgery. Ninety nine knees in 96 patients were examined. The predominant diagnoses were lesions of the medial meniscus (33%), ruptures of the anterior cruciate ligament (30%) and lesions of the lateral meniscus (20%). Fourteen knees (14%) were normal. There was one postoperative infection, 3 patients had troublesome effusions and one patient developed a synovial fistula. Two patients required overnight admission. The waiting list was reduced from 14.7 weeks to 3.0 weeks. The advantages and limitations of this technique is discussed. PMID:3674684

Allum, R L; Ribbans, W J

1987-09-01

332

Day case arthroscopy and arthroscopic surgery of the knee.  

PubMed Central

A Day Case Unit was opened at Wexham Park Hospital in October 1985 and this paper describes the first year's experience in arthroscopy and arthroscopic surgery. Ninety nine knees in 96 patients were examined. The predominant diagnoses were lesions of the medial meniscus (33%), ruptures of the anterior cruciate ligament (30%) and lesions of the lateral meniscus (20%). Fourteen knees (14%) were normal. There was one postoperative infection, 3 patients had troublesome effusions and one patient developed a synovial fistula. Two patients required overnight admission. The waiting list was reduced from 14.7 weeks to 3.0 weeks. The advantages and limitations of this technique is discussed.

Allum, R. L.; Ribbans, W. J.

1987-01-01

333

Isolated total ruptures of the anterior cruciate ligament--a clinical study with long-term follow-up of 7 years.  

PubMed

Seventy patients met our inclusion criteria in this retrospective study, all with an arthroscopic/arthrotomic-verified isolated total anterior cruciate ligament (ACL)-rupture and a minimum follow-up period of 3 years and no associated lesions. Due to emigration/death, 3 patients were not available for follow-up. Of the remaining 67, 25 patients underwent secondary ACL-reconstruction, equivalent to a failure rate of the initial non-operative treatment of 37%. All patients were initially treated conservatively. This left 42 patients for follow-up--9 answered a questionnare and 33 went through follow-up examination after a median of 7.1 years (range 3.3 14.6) including IKDC-evaluation form, Lysholm & Tegner score, ES-SKA-score, clinical examination and Stryker Laxity test. In the present study all values represent the 33 patients available for follow-up. Soccer, handball and alpine skiing were most frequently responsible for the injury. We observed in the 33 patients a decline in median Lysholm score from 100 (90-100) pretraumatic to 86 (42-100) at follow-up, and a decrease in median Tegner values from 7 (3-9) pretraumatic to 5 (2-7) at follow-up. All but 2 patients demonstrated a decline in Lysholm score, and only 3 patients returned to their preinjury level. According to the ESSKA-classification, the number of "cutting-sports performers" declined dramatically from 24 to 2. All but one patient ascribed their decline in activity to their knee status. The Stryker-measured AP-translocations were significantly higher on the injured knee (7.27) compared to the healthy knee (4.80) (P < 0.05). Intermittant rest pain was suffered by 63% of the patients. During the time from inclusion until follow-up, 13 (39%) patients sustained an additional ipsilateral knee lesion, most commonly a tear of the medial meniscus. The overall outcome was expressed in a low frequency of return to unrestricted preinjury level of function, and a high level of instability complaints resulting in many secondary ACL-reconstructions. Naturally some have adapted to their ultimate functional disability, but only through modification of activities, and the overall outcome after conservative therapy of these ACL-ruptures was not satisfactory. PMID:10220847

Scavenius, M; Bak, K; Hansen, S; Nørring, K; Jensen, K H; Jørgensen, U

1999-04-01

334

Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal  

PubMed Central

Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur.

Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

2013-01-01

335

Effects of Closed Kinetic Chain Exercises on Proprioception and Functional Scores of the Knee after Anterior Cruciate Ligament Reconstruction  

PubMed Central

[Purpose] The purpose of this study was to examine the effect of closed kinetic chain exercises performed by an unstable exercise group (UEG) and a stable exercise group (SEG) on the knee joint, proprioception, and functional scores of patients who underwent anterior cruciate ligament (ACL) reconstruction. [Subjects] Twenty-eight patients participated in this study. The exclusion criteria were fracture or neurological disease. [Methods] The subjects were randomly assigned to one of two groups, each with 14 people. Each group took part in a 60-minute exercise program, three times a week for six weeks. [Results] The results of the clinical evaluation at 45°proprioception showed statistically significant differences between the two groups. The results of the clinical evaluation at 15°proprioception showed no statistically significant differences between the two groups. [Conclusion] The proprioception and functional scores of the patients in the UEG who underwent ACL reconstruction were superior to those in the SEG group.

Cho, Sung-Hyoun; Bae, Chang-Hwan; Gak, Hwang-Bo

2013-01-01

336

Correlation of joint line tenderness and meniscus pathology in patients with subacute and chronic anterior cruciate ligament injuries.  

PubMed

We evaluated joint line tenderness (JLT) as a test for meniscus pathology in 3531 patients who underwent anterior cruciate ligament (ACL) reconstruction >30 days postinjury. If the patient had no additional giving-way episode after the index ACL injury, the injury was considered subacute; otherwise, it was considered chronic. Immediately before surgery, the presence or absence of medial or lateral JLT was evaluated. During ACL reconstruction, the presence or absence of meniscal tears was documented. In the subacute population, JLT was 41% sensitive, 56% specific, and 50% accurate for detecting medial meniscal tears and 57% sensitive, 44% specific, and 49% accurate for detecting lateral meniscal tears. In the chronic population, JLT was 55% sensitive, 50% specific, and 52% accurate for detecting medial meniscal tears and 46% sensitive, 52% specific, and 50% accurate for detecting lateral meniscal tears. The presence of JLT alone should not be used in the clinical decision making process to guide treatment. PMID:19634720

Shelbourne, K Donald; Benner, Rodney W

2009-07-01

337

Lateral meniscal tear resulting from the femoral cross-pin used for hamstring graft fixation in anterior cruciate ligament reconstruction.  

PubMed

We report a case of lateral meniscal tear resulting from the femoral cross-pin used for hamstring graft fixation in anterior cruciate ligament (ACL) reconstruction. A 29 year old man presented with symptoms of knee pain, catching and locking, 13 months following an ACL reconstruction. Magnetic resonance imaging (MRI) and arthroscopy confirmed the broken femoral cross-pin abutting the lateral meniscus and the resulting meniscal tear. Removal of the broken femoral cross-pin and repair of the lateral meniscal tear resulted in resolution of symptoms. Distal femoral cross-pin fracture and its intra-articular position are postulated as the cause of this lateral meniscal tear. Hence, we recommend a low threshold to investigate with a MRI scan any new symptoms following ACL reconstruction with cross-pin fixation. PMID:22520571

Dudhniwala, A G; Rath, N; Forster, M C

2012-12-01

338

The incidence of knee and anterior cruciate ligament injuries over one decade in the Belgian Soccer League.  

PubMed

In an epidemiological study we assessed the evolution in the incidence and possible risk factors of knee injuries, especially anterior cruciate ligament (ACL) injuries, in Belgian soccer over one decade. Two soccer seasons (1999-2000 and 2009-2010) were compared and 56,364 injury reports registered by the KBVB-URBSFA were retrieved. Knee injuries totaled 9.971 cases, 5.495 in the first season (1999-2000) and 4.476 in the second (2009-2010): a significant decrease in incidence from 1.5 per 100 players in 2000 to 1.2 knee injuries in 2010. Six percent of all knee injuries were ACL injuries. The reported incidence of ACL tears slightly increased from 0.081 to 0.084 per 100 players. Female gender, competition and age over 18 years were prognosticators for ACL injuries. Enhanced prevention programs for ACL injuries, especially in those sports groups are warranted. PMID:24350516

Quisquater, Laurent; Bollars, Peter; Vanlommel, Luc; Claes, Steven; Corten, Kristoff; Bellemans, Johan

2013-10-01

339

Arthroscopic bioabsorbable tack stabilization of initial anterior shoulder dislocations: A preliminary report  

Microsoft Academic Search

Twenty-six consecutive cadet athletes sustained an acute, initial anterior shoulder dislocation. All dislocations required a manual reduction for initial treatment. Arthroscopy was performed within 10 days in all patients. The Beach chair position and interscalene anesthesia were used in each case. At arthroscopy, 25 patients had an avulsion of the anterior-inferior capsulolabral complex (Bankart lesion) from the glenoid rim. One

Robert A. Arciero; Dean C. Taylor; Robert J. Snyder; John M. Uhorchak

1995-01-01

340

Clinical Correlates to Laboratory Measures for use in Non-Contact Anterior Cruciate Ligament Injury Risk Prediction Algorithm  

PubMed Central

Background Prospective measures of high knee abduction moment during landing identify female athletes at high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status. Methods Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction. Findings Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including (Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30–1.59 cm), knee flexion range of motion (.98:0.96–1.01 deg), body mass (1.04:1.02–1.06 kg), tibia length (1.38:1.25–1.52 cm) and quadriceps to hamstring ratio (1.70:1.06–2.70) predicted high knee abduction moment status with C statistic 0.81. Interpretation The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity.

Myer, Gregory D.; Ford, Kevin R.; Khoury, Jane; Succop, Paul; Hewett, Timothy E.

2010-01-01

341

Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature  

PubMed Central

Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up.

Wong, Jessica J.; Muir, Brad

2013-01-01

342

Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature.  

PubMed

Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up. PMID:23754857

Wong, Jessica J; Muir, Brad

2013-06-01

343

Arthroscopic Hybrid Fixation of a Tibial Eminence Fracture in Children  

PubMed Central

The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients.

Kim, Jong In; Kwon, Jae Ho; Seo, Dong Hyun; Soni, Shaishav M.; Munoz, Michael; Nha, Kyung Wook

2013-01-01

344

Arthroscopic Repair of Chronic Bony Bankart Lesion Using a Low Anterior Portal  

PubMed Central

We describe the repair of a chronic bony Bankart lesion in a case with recurrent instability using standard techniques and equipment for addressing anteroinferior glenohumeral instability. A 25-year-old man with recurrent instability and a chronic bony Bankart lesion with a Hill-Sachs lesion was treated. The inferior 2 sutures and knotless anchors are placed through a low anterior portal, which improves the angle of approach to the inferior portion of the glenoid that is fractured. The knotless anchors are impacted through the low anterior portal, just superior to the level of the suture, as the fragment tends to retract medially and inferiorly, with the drill guide slightly on the face of the glenoid. The superior-anterior portal adjacent to the biceps tendon gives a better view of the glenoid articular cartilage position of the anchors required to restore the anatomic location of the fracture fragment. The low anterior portal improved and simplified the reduction of the fracture fragment to the glenoid neck by allowing access to the anterior-inferior bony Bankart lesion that was repairable with suture and knotless anchors using standardized techniques.

Brand, Jefferson C.; Westerberg, Paul

2012-01-01

345

Assessment of standing balance deficits in people who have undergone anterior cruciate ligament reconstruction using traditional and modern analysis methods.  

PubMed

Modern methods of assessing standing balance such as wavelet and entropy analysis could provide insight into postural control mechanisms in clinical populations. The aim of this study was to examine what effect anterior cruciate ligament reconstruction (ACLR) has on traditional and modern measures of balance. Ninety subjects, 45 who had undergone ACLR and 45 matched controls, performed single leg static standing balance tests on their surgical or matched limb on a Nintendo Wii Balance Board. Data were analysed in the anterior-posterior axis of movement, which is known to be affected by ACLR. The traditional measures of path velocity, amplitude and standard deviation were calculated in this plane. Additionally, sample entropy and discrete wavelet transform derived assessment of path velocity in four distinct frequency bands related to (1) spinal reflexive loops and muscle activity, (2) cerebellar, (3) vestibular, and (4) visual mechanisms of postural control were derived. The ACLR group had significantly increased values in all traditional measures and all four frequency bands. No significant difference was observed for sample entropy. This indicated that whilst postural sway was amplified in the ACLR group, the overall mechanism used by the patient group to maintain balance was similar to that of the control group. In conclusion, modern methods of signal analysis may provide additional insight into standing balance mechanisms in clinical populations. Future research is required to determine if these results provide important and unique information which is of benefit to clinicians. PMID:24433669

Clark, Ross A; Howells, Brooke; Pua, Yong-Hao; Feller, Julian; Whitehead, Tim; Webster, Kate E

2014-03-21

346

Pre-operative versus post-operative gait variability in patients with acute anterior cruciate ligament deficiency.  

PubMed

Change in gait variability at least 6 months after surgical reconstruction of the anterior cruciate ligament (ACL) was assessed in 20 male patients with acute ACL deficiency and compared with pre-operative data and that from 20 healthy male controls. Gait was measured using a triaxial accelerometer and data were analysed by the Gait Evaluation Differential Entropy Method (GEDEM) to determine gait variability. Pain was assessed with a visual analogue scale and functional ability with the Oswestry Disability Index and the International Knee Documentation Committee score. Mean gait variability was significantly lower after than before surgery, with values for the anterior-posterior axis being in the normal range of controls after 6 months, whereas in the mediolateral axis mean gait variability remained significantly higher, indicating that some rotational instability remained in the time-frame of the study. Pain and functional ability scores improved after surgery compared with before surgery. The combination of accelerometry and GEDEM may be a useful orthopaedic tool for the post-operative evaluation of patients who have undergone ACL reconstruction. PMID:21672363

Tsivgoulis, S D; Tzagarakis, G N; Papagelopoulos, P J; Koulalis, D; Sakellariou, V I; Kampanis, N A; Chlouverakis, G I; Alpantaki, K I; Nikolaou, P K; Katonis, P G

2011-01-01

347

Inter-rater reliability of Rolimeter measurements between anterior cruciate ligament injured and normal contra lateral knees.  

PubMed

The Rolimeter device can provide measurements of anterior/posterior tibial displacement using maximal manual force. The Rolimeter reliability is still under research when used as an independent knee tester. The purpose of this study is to determine the inter-rater reliability of the Rolimeter measurements between anterior cruciate ligament (ACL) injured and normal contra lateral knees. Twelve male patients with ACL deficiency participated in this study. Three physical therapists (PT) performed the Rolimeter measurements in supine position with an approximate 25 degrees flexion of the knees. Each therapist performed three trials on each knee and the difference in results in millimeters between injured knee and normal contra lateral knee was determined. Spearman's rho correlations showed weak relationships between the PT 1, 3 and 2, 3 (PT 1 vs. PT 3 r=0.55, PT 2 vs. PT 3 r=0.57) and the high relation between 1, 2 (PT 1 vs. PT 2 r=0.96) of Rolimeter measurements. Intraclass correlation coefficient showed no significant reliability coefficients among the three PT Rolimeter measurements between ACL injured and normal contra lateral knees (R=0.24, p=0.05). These results reflect the variations among the means of the three physical therapists' Rolimeter measurements between ACL injured and normal contra lateral knees. PMID:15645211

Papandreou, Maria G; Antonogiannakis, Emmanuel; Karabalis, Christos; Karliaftis, Konstantinos

2005-10-01

348

The effects of graft width and graft laxity on the outcome of caprine anterior cruciate ligament reconstruction.  

PubMed

We studied how initial graft size and initial graft laxity affected the biomechanics of anterior cruciate ligament (ACL) reconstruction at six months. Sixteen goats had bilateral reconstructions staged eight weeks apart. Autografts 4 and 7 mm wide were taken from the central patellar tendon (PT). Lax grafts were created by adding 4 mm slack to the graft before fixing. We reconstructed each joint using a combination of width and laxity treatments. Both factors were changed for the contralateral joint and all combinations appeared with equal frequency. At six months we measured the joint extension limit, anterior-posterior (AP) translation, and osteoarthritic changes. The grafts were then tested to failure to determine their mechanical properties. After six months the difference in initial treatments had disappeared: there was no difference in graft cross-section due to the different initial widths and there was no difference in joint AP translation due to the initial graft laxity. We did observe that wide grafts were associated with a block to extension, decreased joint AP translation, and increased articular cartilage damage and osteophyte formation. While AP translation was reduced, it was correlated with decreased extension, possibly indicating an increase in scar tissue formation rather than a more functional graft. Neither graft width nor graft laxity produced differences in any graft mechanical properties. This suggests that the use of larger grafts to prevent increased AP translation has undesirable complications. Ultimately, we conclude that neither of these surgical treatments strongly affects the biomechanical result of caprine ACL reconstruction. PMID:11918314

Cummings, J F; Grood, E S; Levy, M S; Korvick, D L; Wyatt, R; Noyes, F R

2002-03-01

349

The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: Evaluation using a robotic testing system  

Microsoft Academic Search

Despite its current popularity and relative success, endoscopic reconstruction of the anterior cruciate ligament (ACL) using a bone-patellar tendon-bone (BPTB) graft has not yet been perfected. Using a recently developed robotic\\/UFS testing system, we assessed the overall stability of porcine knees following ACL reconstruction with different sites of tibial graft fixation—proximal, central, and distal. Testing of the intact knee was

Yasuyuki Ishibashi; Theodore W. Rudy; Glen A. Livesay; Jeffrey D. Stone; Freddie H. Fu; Savio L.-Y. Woo

1997-01-01

350

Patellar Tendon Versus Hamstring Tendon Autografts for Reconstructing the Anterior Cruciate LigamentA Meta-Analysis Based on Individual Patient Data  

Microsoft Academic Search

Background: The best means of ensuring knee stability after anterior cruciate ligament (ACL) reconstruction remains a core debate in sports medicine.Hypothesis: There is no difference between ACL reconstruction with patellar tendon or hamstring tendon autografts with regard to postoperative knee laxity and instability.Study Design: Meta-analysis of individual patient data.Methods: Pooled analysis of individual patient data from 6 published randomized clinical

David Jean Biau; Sandrine Katsahian; Jüri Kartus; Arsi Harilainen; Julian A. Feller; Matjaz Sajovic; Lars Ejerhed; Stefano Zaffagnini; Martin Röpke; Rémy Nizard

2009-01-01

351

A 10Year Comparison of Anterior Cruciate Ligament Reconstructions With Hamstring Tendon and Patellar Tendon AutograftA Controlled, Prospective Trial  

Microsoft Academic Search

Background: There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts.Hypothesis: Comparable results are possible with HT and PT autografts.Study Design: Cohort study; Level of evidence, 2.Methods: One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT

Leo A. Pinczewski; Jeffrey Lyman; Lucy J. Salmon; Vivianne J. Russell; Justin Roe; James Linklater

2007-01-01

352

New insights into anterior cruciate ligament deficiency and reconstruction through the assessment of knee kinematic variability in terms of nonlinear dynamics  

Microsoft Academic Search

Purpose  Injuries to the anterior cruciate ligament (ACL) occur frequently, particularly in young adult athletes, and represent the\\u000a majority of the lesions of knee ligaments. Recent investigations suggest that the assessment of kinematic variability using\\u000a measures of nonlinear dynamics can provide with important insights with respect to physiological and pathological states.\\u000a The purpose of the present article was to critically review

Leslie M. Decker; Constantina Moraiti; Nicholas Stergiou; Anastasios D. Georgoulis

353

Iliotibial band friction syndrome after anterior cruciate ligament reconstruction using the transfix device: report of two cases and review of the literature  

Microsoft Academic Search

The use of hamstrings is increasing as a treatment for anterior cruciate ligament (ACL) injuries. There are a lot of new devices\\u000a and techniques that try to fix the graft without causing further injury or increased morbidity. We report two cases in relation\\u000a to the transfix device for reconstructing the ACL. The first case is a 38-year-old female who was

Xavier Pelfort; Joan C. Monllau; LLuís Puig; Enric Cáceres

2006-01-01

354

Medium-Term Course of Clinical Function and Progression of Osteoarthritis after Primary Reconstruction of Anterior Cruciate Ligament: 5- to 8Year Results  

Microsoft Academic Search

This retrospective study reveals medium-term postoperative results in anterior cruciate ligament reconstruction with a bone-tendon-bone autograft of the middle third of the patellar ligament, 5 to 8 years after surgery. A total of 44 patients with a mean age of 34.7 years was followed up for an average of 72.5 months. Objective stability of the knee was evaluated by means

Alwin Jäger; Christian Eberhardt; Andreas H. Kurth; Markus Rittmeister

2000-01-01

355

Simple solution for failure of trailing sutures when using the EndoButton in anterior cruciate ligament reconstruction: the "Rescue Rein".  

PubMed

In this article, we introduce the technique of adding a second suture in the distal hole of the EndoButton. This suture, the "Rescue Rein," is kept with the graft and is a simple solution for recovering the graft during anterior cruciate ligament reconstruction when the EndoButton becomes jammed within the femoral tunnel and the trailing sutures cannot be removed. PMID:16086568

Vega, Rafael; Irribarra, Luis; Filippi, Jorge

2005-08-01

356

Bone-patellar tendon-bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis  

PubMed Central

Objectives To compare bone-patellar tendon-bone autografts with hamstring autografts for reconstruction of the anterior cruciate ligament. Data sources Medline, WebSPIRS, Science Citation Index, Current Contents databases, and Cochrane Central Register of Controlled Trials. Review methods All randomised controlled trials reporting one or more outcome related to stability (instrumented measurement of knee laxity, Lachman test, or pivot shift test) and morbidity (anterior knee pain, kneeling test, loss of extension, or graft failure). Study quality was assessed by using a 5 point scale. Random effect models were used to pool the data. Heterogeneity in the effect of treatment was tested on the basis of study quality, randomisation status, and number of tendon strands used. Results 24 trials of 18 cohorts (1512 patients) met the inclusion criteria. Study quality was poor for nine studies and fair for nine studies. The weighted mean difference of the instrumented measurement of knee laxity was 0.36 (95% confidence interval 0.01 to 0.71; P = 0.04). Relative risk of a positive Lachman test was 1.22 (1.01 to 1.47; P = 0.04), of anterior knee pain 0.57 (0.44 to 0.74; P < 0.0001), of a positive kneeling test 0.26 (0.14 to 0.48; P < 0.0001), and of loss of extension 0.52 (0.34 to 0.80; P = 0.003). Other results were not significant. Conclusion Morbidity was lower for hamstring autografts than for patellar tendon autografts. Evidence that patellar tendon autografts offer better stability was weak. The poor quality of the studies calls into question the robustness of the analyses.

Biau, David J; Tournoux, Caroline; Katsahian, Sandrine; Schranz, Peter J; Nizard, Remy S

2006-01-01

357

Can magnetic resonance imaging findings predict the degree of knee joint laxity in patients undergoing anterior cruciate ligament reconstruction?  

PubMed Central

Background The present study was performed to determine whether MRI findings can predict the degree of knee joint laxity in patients undergoing ACL reconstruction and whether the accuracy of the prediction is affected by the MRI acquisition time. Methods We assessed prospectively collected data of 154 knees with ACL tears. The presence or absence of four primary findings of ACL tears, i.e., nonvisualization, discontinuity, abnormal signal intensity, and abnormal shape of the ACL, and five secondary findings, i.e., anterior translation of the tibia relative to the femur (?7 mm), posterior cruciate ligament angle (<105°), bone contusion, Segond fracture, and the deep sulcus sign, were determined. Knee joint laxity was assessed using the Lachman and pivot shift tests. The associations between MRI findings and clinically assessed knee joint laxity were analyzed and compared between subgroups (?3 months from injury to MRI, 89 knees; >3 months, 65 knees). Results Nonvisualization was related to the results of the Lachman test [Odds ratio (OR), 2.6; 95% confidence interval (CI), 1.2–5.5]. Anterior translation of the tibia relative to the femur was related to the results of the pivot shift test (OR, 3.8; 95% CI, 1.6–9.4). In subgroup comparisons of the early and late MRI groups, anterior translation of the tibia relative to the femur was related to the results of the pivot shift test in the early MRI group (OR, 4.5; 95% CI, 1.4–14.4). In contrast, no MRI findings had statistically significant relationships with physical findings in the late MRI group. Conclusions Our study indicates that MRI findings may have some usefulness for predicting the grade of knee laxity in patients with symptomatic ACL injury, but its value is limited, especially in patients with a longer time interval between injury and the performance of MRI.

2014-01-01

358

A three-dimensional finite element model of the human anterior cruciate ligament: a computational analysis with experimental validation.  

PubMed

In this study, the force and stress distribution within the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) in response to an anterior tibial load with the knee at full extension was calculated using a validated three-dimensional finite element model (FEM) of a human ACL. The interaction between the AM and PL bundles, as well as the contact and friction caused by the ACL wrapping around the bone during knee motion, were included in the model. The AM and PL bundles of the ACL were simulated as incompressible homogeneous and isotropic hyperelastic materials. The multiple-degrees-of-freedom (DOF) knee kinematics of a cadaveric knee were first obtained using a robotic/universal force-moment sensor testing system. These data were used as the boundary conditions for the FEM of the ACL to calculate the forces in the ACL. The calculated forces were compared to the in situ force in the ACL, determined experimentally, to validate the model. The validated FEM was then used to calculate the force and stress distribution within the ACL under an anterior tibial load at full extension. The AM and PL bundles shared the force, and the stress distribution was non-uniform within both bundles with the highest stress localized near the femoral insertion site. The contact and friction caused by the ACL wrapping around the bone during knee motion played the role of transferring the force from the ACL to the bone, and had a direct effect on the force and stress distribution of the ACL. This validated model will enable the analysis of force and stress distribution in the ACL in response to more complex loading conditions and has the potential to help design improved surgical procedures following ACL injuries. PMID:14757458

Song, Yuhua; Debski, Richard E; Musahl, Volker; Thomas, Maribeth; Woo, Savio L-Y

2004-03-01

359

Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study  

PubMed Central

Purpose Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction. Materials and Methods The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated. Results The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane. Conclusions In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate.

Lee, Kwang Won; Chi, Yong Joo; Yang, Dae Suk; Kim, Ha Yong; Choy, Won Sik

2014-01-01

360

Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew  

PubMed Central

Background Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. Methods Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. Results Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. Conclusions Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.

Kim, Doo-Sup; Yi, Chang-Ho; Chung, Hoi-Jung

2011-01-01

361

Influence of Functional Knee Bracing on the Isokinetic and Functional Tests of Anterior Cruciate Ligament Deficient Patients  

PubMed Central

Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in Anterior cruciate ligament(ACL)-injured patients. However, many athletes might refrain from wearing the braces because of the fear of performance hindrance in the playing field. The aim of this study was to examine the effect of three functional knee brace/sleeves upon the isokinetic and functional performance of ACL-deficient and healthy subjects. Six anterior cruciate ligament deficient (29.0±5.3 yrs., 175.2±5.4 cm, and 73.0±10.0 kg) and six healthy male subjects (27.2±3.7 yrs., 176.4±6.4 cm, and 70.3±6.9 kg) were selected. The effect of a custom-made functional knee brace, and two neoprene knee sleeves, one with four metal supports and one without support were examined via the use of isokinetic and functional tests in four sets (non-braced,wearing functional knee brace,and wearing the sleeves). Cross-over hop and single leg vertical jump test were performed and jump height, and hop distance were recorded. Peak torque to body weight ratio and average power in two isokinetic velocities(60°.s?1,180°.s?1) were recorded and the brace/sleeves effect was calculated as the changes in peak torque measured in the brace/sleeves conditions, expressed as a percentage of peak torque measured in non-braced condition. Frequency content of the isokinetic torque-time curves was also analyzed. Wilcoxon signed rank test was used to compare the measured values in four test conditions within each control and ACL-deficient group,and Mann-Whitney U test was used for the comparison between the two groups. No significant differences in peak torque, average power, torque-time curve frequency content, vertical-jump and hop measurements were found within the experimental and the non-braced conditions (p>0.05). Although the examined functional knee brace/sleeves had no significant effect on the knee muscle performance, there have been some enhancement regarding the extension peak torques and power generating capacity of the ACL-deficient subjects that could be helpful in reducing the bilateral asymmetry in these patients.

Mortaza, Niyousha; Abu Osman, Noor Azuan; Jamshidi, Ali Ashraf; Razjouyan, Javad

2013-01-01

362

Influence of functional knee bracing on the isokinetic and functional tests of anterior cruciate ligament deficient patients.  

PubMed

Use of functional knee braces has been suggested to provide protection and to improve kinetic performance of the knee in Anterior cruciate ligament(ACL)-injured patients. However, many athletes might refrain from wearing the braces because of the fear of performance hindrance in the playing field. The aim of this study was to examine the effect of three functional knee brace/sleeves upon the isokinetic and functional performance of ACL-deficient and healthy subjects. Six anterior cruciate ligament deficient (29.0 ± 5.3 yrs., 175.2 ± 5.4 cm, and 73.0 ± 10.0 kg) and six healthy male subjects (27.2 ± 3.7 yrs., 176.4 ± 6.4 cm, and 70.3 ± 6.9 kg) were selected. The effect of a custom-made functional knee brace, and two neoprene knee sleeves, one with four metal supports and one without support were examined via the use of isokinetic and functional tests in four sets (non-braced,wearing functional knee brace,and wearing the sleeves). Cross-over hop and single leg vertical jump test were performed and jump height, and hop distance were recorded. Peak torque to body weight ratio and average power in two isokinetic velocities(60°.s(-1),180°.s(-1)) were recorded and the brace/sleeves effect was calculated as the changes in peak torque measured in the brace/sleeves conditions, expressed as a percentage of peak torque measured in non-braced condition. Frequency content of the isokinetic torque-time curves was also analyzed. Wilcoxon signed rank test was used to compare the measured values in four test conditions within each control and ACL-deficient group,and Mann-Whitney U test was used for the comparison between the two groups. No significant differences in peak torque, average power, torque-time curve frequency content, vertical-jump and hop measurements were found within the experimental and the non-braced conditions (p>0.05). Although the examined functional knee brace/sleeves had no significant effect on the knee muscle performance, there have been some enhancement regarding the extension peak torques and power generating capacity of the ACL-deficient subjects that could be helpful in reducing the bilateral asymmetry in these patients. PMID:23717593

Mortaza, Niyousha; Abu Osman, Noor Azuan; Jamshidi, Ali Ashraf; Razjouyan, Javad

2013-01-01

363

Magnetic resonance imaging analysis of the bioabsorbable Milagro interference screw for graft fixation in anterior cruciate ligament reconstruction.  

PubMed

Ligament graft fixation with bioabsorbable interference screws is a standard procedure in cruciate ligament replacement. Previous screw designs may resorb incompletely, and can cause osteolysis and sterile cysts despite being implanted for several years. The aim of this study was to examine the in vivo degradation and biocompatibility of the new Milagro interference screw (Mitek, Norderstedt, Germany). The Milagro interference screw is made of 30% ss-TCP (TriCalcium phosphate) and 70% PLGA (Poly-lactic-co-glycolic acid). In the period between June 2005 and February 2006, 38 patients underwent graft fixation with Milagro screws in our hospital. Arthroscopic ACL reconstruction was performed using hamstring tendon grafts in all the patients. MR imaging was performed on 12 randomly selected patients out of the total of 38 at 3, 6 and 12 months after surgery. During the examination, the volume loss of the screw, tunnel enlargement, presence of osteolysis, fluid lines, edema and postoperative screw replacement by bone tissue were evaluated. There was no edema or signs of inflammation around the bone tunnels. At 3, 6 and 12 months, the tibial screws showed an average volume loss of 0, 8.1% (+/-7.9%) and 82.6% (+/-17.2%, P < 0.05), respectively. The femoral screws showed volume losses of 2.5% (+/-2.1%), 31.3% (+/-21.6%) and 92.02% (+/-6.3%, P < 0.05), respectively. The femoral tunnel enlargement was 47.4% (+/-43.8%) of the original bone tunnel volume after 12 months, and the mean tunnel volume of the tibial tunnel was -9.5% (+/-58.1%) compared to the original tunnel. Bone ingrowth was observed in all the patients. In conclusion, the resorption behaviour of the Milagro screw is closely linked to the graft healing process. The screws were rapidly resorbed after 6 months and, at 12 months, only the screw remnants were detectable. Moreover, the Milagro screw is biocompatible and osteoconductive, promoting bone ingrowth during resorption. Tunnel enlargement is not prevented in the first months but is reduced by bone ingrowth after 12 months. PMID:19697105

Frosch, K-H; Sawallich, T; Schütze, G; Losch, A; Walde, T; Balcarek, P; Konietschke, F; Stürmer, K M

2009-10-01

364

Augmentation of Bone Tunnel Healing in Anterior Cruciate Ligament Grafts: Application of Calcium Phosphates and Other Materials  

PubMed Central

Bone tunnel healing is an important consideration after anterior cruciate ligament (ACL) replacement surgery. Recently, a variety of materials have been proposed for improving this healing process, including autologous bone tissue, cells, artificial proteins, and calcium salts. Amongst these materials are calcium phosphates (CaPs), which are known for their biocompatibility and are widely commercially available. As with the majority of the materials investigated, CaPs have been shown to advance the healing of bone tunnel tissue in animal studies. Mechanical testing shows fixation strengths to be improved, particularly by the application of CaP-based cement in the bone tunnel. Significantly, CaP-based cements have been shown to produce improvements comparable to those induced by potentially more complex treatments such as biologics (including fibronectin and chitin) and cultured cells. Further investigation of CaP-based treatment in the bone tunnels during ACL replacement is therefore warranted in order to establish what improvements in healing and resulting clinical benefits may be achieved through its application.

Baxter, F. R.; Bach, J. S.; Detrez, F.; Cantournet, S.; Corte, L.; Cherkaoui, M.; Ku, D. N.

2010-01-01

365

The mechanical properties of skeletally mature rabbit anterior cruciate ligament and patellar tendon over a range of strain rates.  

PubMed

The effect of strain rate on the mechanical properties of the rabbit anterior cruciate ligament (ACL) and patellar tendon (PT) was evaluated. The medial portion of the ACL was loaded to tensile failure at rates of 0.003, 0.3, and 113 mm/s, and the middle third of the PT was loaded at rates of 0.008, 0.8, and 113 mm/s. The load was recorded with a high-speed measurement plotting system, and each test was videotaped for strain analysis. The nonlinear portion of the stress-strain curve was curve-fit to an exponential function having two nonlinear constants, representing the initial modulus and rate of change of the modulus. The modulus of the rabbit PT was found to be 89% higher than that of the ACL. The initial modulus and rate of change of the modulus also were greater for the PT than for the ACL. The modulus of the PT was shown to be more sensitive to strain rate than that of the ACL; a 94% increase was observed for the PT, and a 31% increase was observed for the ACL. There was no effect of strain rate on the mode of failure of either the ACL or the PT; all but three of the specimens failed at the insertion site. PMID:8423521

Danto, M I; Woo, S L

1993-01-01

366

Long-term effects of knitted silk-collagen sponge scaffold on anterior cruciate ligament reconstruction and osteoarthritis prevention.  

PubMed

Anterior cruciate ligament (ACL) is difficult to heal after injury due to the dynamic fluid environment of joint. Previously, we have achieved satisfactory regeneration of subcutaneous tendon/ligament with knitted silk-collagen sponge scaffold due to its specific "internal-space-preservation" property. This study aims to investigate the long-term effects of knitted silk-collagen sponge scaffold on ACL regeneration and osteoarthritis prevention. The knitted silk-collagen sponge scaffold was fabricated and implanted into a rabbit ACL injury model. The knitted silk-collagen sponge scaffold was found to enhance migration and adhesion of spindle-shaped cells into the scaffold at 2 months post-surgery. After 6 months, ACL treated with the knitted silk-collagen sponge scaffold exhibited increased expression of ligament genes and better microstructural morphology. After 18 months, the knitted silk-collagen sponge scaffold-treated group had more mature ligament structure and direct ligament-to-bone healing. Implanted knitted silk-collagen sponge scaffolds degraded much more slowly compared to subcutaneous implantation. Furthermore, the knitted silk-collagen sponge scaffold effectively protected joint surface cartilage and preserved joint space for up to 18 months post-surgery. These findings thus demonstrated that the knitted silk-collagen sponge scaffold can regenerate functional ACL and prevent osteoarthritis in the long-term, suggesting its clinical use as a functional bioscaffold for ACL reconstruction. PMID:24974007

Shen, Weiliang; Chen, Xiao; Hu, Yejun; Yin, Zi; Zhu, Ting; Hu, Jiajie; Chen, Jialin; Zheng, Zefeng; Zhang, Wei; Ran, Jisheng; Heng, Boon Chin; Ji, Junfeng; Chen, Weishan; Ouyang, Hong-Wei

2014-09-01

367

An examination of possible quadriceps force at the time of anterior cruciate ligament injury during landing: A simulation study.  

PubMed

Anterior cruciate ligament (ACL) rupture is a common and traumatic injury. Although, identifying the mechanism of ACL injury has received considerable research attention, there are still many unanswered questions. One proposed mechanism asserts that the ACL is injured due to an aggressive quadriceps muscle contraction. However, recently it has been questioned if the magnitude of quadriceps force needed to tear the ACL is physiologically realistic under the conditions where injury occurs during landing (e.g. near full knee extension and within 50ms after impact). To answer this question, a simple simulation model was developed to examine the upper bounds of quadriceps force that can be developed under these conditions. The model included force-length, and force-velocity properties as well as activation dynamics. Model parameters were chosen to provide a high estimate for possible quadriceps force in a young healthy man. The effects of varying quadriceps pre-activation levels were also examined. When using realistic pre-activation levels, the simulated quadriceps force was less than half of what has been shown to cause ACL injury. Even when using maximum pre-activation, the quadriceps force still did not reach close to the level shown to cause injury. Therefore, we conclude that quadriceps force alone seems to be an unlikely mechanism for ACL injury. PMID:21457987

Domire, Zachary J; Boros, Rhonda L; Hashemi, Javad

2011-05-17

368

Change in the cross-sectional area of a patellar tendon graft after anterior cruciate ligament reconstruction.  

PubMed

The purpose of this study was to clarify the change in the cross-sectional area (CSA) of a patellar tendon graft after anterior cruciate ligament (ACL) reconstruction, and its relationship with postoperative knee laxity. Forty patients (25 men and 15 women) were included in this study. Intraoperative CSA measurements were performed with an instrumented areamicrometer, while a magnetic resonance imaging (MRI) evaluation was utilized for the assessment postoperatively. For intraoperative measurement, the average CSA of a 10-mm wide patellar tendon graft was 32.3 +/- 7.0 mm2, while the average CSA measured at follow-up (mean: 14.8 months) was 48.8 mm2, showing a significant mean increase ratio of 49.4%. This value corresponded to 115% of the native ACL. The average CSA measured in 30 patients at 6 months was 49.7 mm2, almost equal to the value at the final follow-up (49.8 mm2) in the same patient group. Among potentially influential factors, postoperative notch width (available space for the ACL graft) had significant correlation with the CSA of the graft at follow-up. Finally, both intra- and postoperative CSA values did not correlate with postoperative knee laxity, indicating that a bigger graft does not guarantee a better laxity. PMID:17031612

Shimizu, K; Yoshiya, S; Kurosaka, M; Sugihara, T; Beppu, M; Aoki, H

2007-05-01

369

All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel  

PubMed Central

Many techniques have been described for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, including extra-articular, complete or partial transphyseal, and physeal-sparing techniques. An all-epiphyseal technique places the tendon and its tunnels and fixation all within the child's epiphysis, leaving the growth plates untouched. We describe an all-epiphyseal quadruple-hamstring ACL reconstruction using a split tibial tunnel. The split tibial tunnels drop the tunnel size down to 4.5 to 5.5 mm from 7 to 8 mm because only half the total graft diameter passes through each of the split tunnels. This increases the safety margin for keeping the tunnel within the tibial epiphysis, in addition to avoiding damage into the growth plate. The bone bridge between the 2 tunnels serves as a solid low-profile fixation post. Femoral graft fixation is achieved with an interference screw, which allows precise tensioning and low-profile fixation entirely within the femoral tunnel. By placing the graft at the native ACL's anatomic attachment points without spanning or violating the growth plates at any step of the procedure, an all-epiphyseal ACL reconstruction with a split tibial tunnel theoretically minimizes the risk of growth disturbance in an ACL-deficient child.

Lykissas, Marios G.; Nathan, Senthil T.; Wall, Eric J.

2012-01-01

370

A Knee-Specific Finite Element Analysis of the Human Anterior Cruciate Ligament Impingement against the Femoral Intercondylar Notch  

PubMed Central

This work presents a finite element analysis of Anterior Cruciate Ligament (ACL) impingement against the intercondylar notch during tibial external rotation and abduction, as a mechanism of noncontact ACL injuries. Experimentally, ACL impingement was measured in a cadaveric knee in terms of impingement contact pressure and six degrees-of-freedom tibiofemoral kinematics. Three-dimensional geometries of the ACL, femur and tibia were incorporated into the finite element model of the individual knee specimen. A fiber-reinforced model was adopted, which accounts for the anisotropy, large deformation, nonlinearity and incompressibility of the ACL. With boundary conditions specified based on the experimental tibiofemoral kinematics, the finite element analysis showed that impingement between the ligament and the lateral wall of intercondylar notch could occur when the knee 45° was externally rotated at 29.1° and abducted at 10.0°. Strong contact pressure and tensile stress occurred at the impinging and nonimpinging sides of the ligament, respectively. The impingement force and contact area estimated from the model matched their counterparts from the corresponding cadaver experiment. The modeling and experimental approach provides a useful tool to characterize potential ACL impingement on a knee-specific basis, which may help elucidate the ACL injury mechanism and develop more effective treatments.

Park, Hyung-Soon; Ahn, Chulhyun; Fung, David T.; Ren, Yupeng; Zhang, Li-Qun

2010-01-01

371

Cross Pins versus Endobutton Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: Minimum 4-Year Follow-Up  

PubMed Central

Purpose We aimed to compare cross-pin fixation and Endobutton femoral fixation for hamstring anterior cruciate ligament (ACL) reconstruction with respect to clinical and radiographic results, including tunnel widening and the progression of knee osteoarthritis (OA). Materials and Methods Between August 2002 and August 2005, 126 autogenous hamstring ACL reconstructions were performed using either cross pins or Endobutton for femoral fixation. Fifty-six of 75 patients in the cross-pin group and 35 of 51 patients in the Endobutton group were followed up for a minimum of 4 years. We compared the clinical and radiological results between the groups using the International Knee Documentation Committee (IKDC) evaluation form, the KT-2000 arthrometer side to side difference, the amount of tunnel widening and the advancement of OA on radiographs. Results There were no significant differences in the IKDC grades between the groups at the 4 year follow-up. There was no significant difference in the side to side difference according to KT-2000 arthrometer testing. Also, there were no significant differences in terms of tunnel widening or advancement of OA on radiographs. Conclusions Endobutton femoral fixation showed good results that were comparable to those of cross pins fixation in hamstring ACL reconstruction.

Kong, Chae-Gwan; Kim, Geon-Hyeong; Ahn, Chi-Young

2012-01-01

372

Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction?  

PubMed

The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique. PMID:23438253

Signorelli, C; Bonanzinga, T; Lopomo, N; Marcheggiani Muccioli, G M; Bignozzi, S; Filardo, G; Zaffagnini, S; Marcacci, M

2013-08-01

373

Assessment of functional impairment after knee anterior cruciate ligament reconstruction using cardiorespiratory parameters: a cross-sectional study  

PubMed Central

Background A dynamic sub-maximum exercise with the same absolute intensity, performed with different muscle groups, may present exacerbated cardiorespiratory responses. Therefore, cardiorespiratory responses to unilateral exercise may identify bilateral differences. The purpose of this study was to verify whether the cardiorespiratory responses to lower limb exercise display counter-lateral differences, and if they could be used to assist athletes and health professionals involved in rehabilitation. Methods Nine individuals participated in this cross-sectional study. They had been treated in a private rehabilitation clinic and submitted to intra-articular reconstruction of the anterior cruciate ligament. The cycling exercise with the same sub-maximal intensity and with one lower limb was used to gather data. Cardiorespiratory responses to exercise were compared between exercises performed with the involved and uninvolved limb after five minutes of exercise. Results Cardiorespiratory responses to exercise performed with the involved limb presented higher values after five minutes of cycling: oxygen uptake (+7%), carbon dioxide production (+10%), minute ventilation (+20%), breathing frequency (+19%), ventilatory equivalent for oxygen (+14%), end-tidal pressure of O2 oxygen (+4%), end-tidal pressure of O2 carbon dioxide (-9%) and heart rate (+9%). Conclusions The exacerbated responses, including increase of the ventilatory equivalent and decrease of end-tidal pressure of carbon dioxide, indicate that this exercise protocol may be useful in the characterization of the functional deficit of the surgical limb during rehabilitation.

2014-01-01

374

Deterioration of stress distribution due to tunnel creation in single-bundle and double-bundle anterior cruciate ligament reconstructions.  

PubMed

Bone tunnel enlargement is a common effect associated with knee laxity after anterior cruciate ligament(ACL) reconstruction. Nevertheless, its exact pathomechanism remains controversial. One of the possible reasons could be bone remodeling due to tunnel creation, which changes the stress environment in the joint. The present study aims to characterize the deteriorated stress distribution on the articular surface, which is due to tunnel creation after single-bundle or double-bundle ACL reconstruction. The stress distributions in the knee following ACL reconstruction under the compression, rotation, and valgus torques were calculated using a validated three-dimensional finite element(FE) model. The results indicate that, (a) under compression,von Mises stress is decreased at lateral and posteromedial regions of single/anteromedial (AM) tunnel, whereas it is increased at anterior region of single/AM tunnel in tibial subchondral bone; (b) the concentration of tensile stress is transferred from the articular surface to the location of graft fixation, and tensile stress in subchondral plate is decreased after ACL reconstruction; (c) severe stress concentration occurs between AM and posterolateral tunnels following the double-bundle reconstruction, which may contribute to the tunnel communication after surgery. In summary, the present study affirms that the deterioration of stress distribution occurs near the articular surface, which may cause the collapse of the tunnel wall, and lead to tunnel enlargement.The present study provides an insight into the effect of tunnel creation on articular stress deterioration after single-bundle or double-bundle ACL reconstruction. These findings provide knowledge on the effect of tunnel enlargement after ACL reconstruction in the long term. PMID:22302321

Yao, Jie; Wen, ChunYi; Cheung, Jason Tak-Man; Zhang, Ming; Hu, Yong; Yan, Chunhoi; Chiu, Kwong-Yuen Peter; Lu, William Weijia; Fan, Yubo

2012-07-01

375

In Vivo T1? Quantitative Assessment of Knee Cartilage After Anterior Cruciate Ligament Injury Using 3 Tesla Magnetic Resonance Imaging  

PubMed Central

Objective The aims of this study were to evaluate the spatial distribution of cartilage structure in controls and patients, and to quantitatively assess the cartilage overlying bone marrow edema-like lesion (BMEL) and within defined cartilage compartments in knees with anterior cruciate ligament (ACL) tears using T1? mapping technique at 3 T magnetic resonance imaging. Materials and Methods The knee joints of 15 healthy controls (4 women, 11 men, mean age = 30.1 year) and 16 patients with ACL tear (5 women, 11 men, mean age = 32.5 years) who showed BMEL was studied using a 3 T GEMR scanner and a quadrature knee coil. The imaging protocol included sequences for cartilage morphology and 3D quantitative T1? mapping. Lateral femoral condyle and medial femoral condyles compartments were partitioned into anterior and posterior nonweight-bearing (ant-nwb and postnwb) portions and weight-bearing (wb) portions in all subjects. In patients only, cartilage overlying BMEL and surrounding cartilage portions were also defined. T1? values were quantified in cartilage overlying BMEL and surrounding compartments and in each defined compartment of the ACL-injured knees, and compared with controls. Results Significantly elevated T1? values were found in the femoral nonweight-bearing (nwb) portions when compared with weight-bearing (wb) portions both in patients and controls. Significantly increased T1? values were found in cartilage overlying BMEL when compared with surrounding cartilage at the lateral tibia (LT), but no difference was found in the lateral femoral condyle. Conclusion T1? mapping technique provides tools to quantitatively evaluate the cartilage matrix overlying BMEL in patients with ACL injuries. Cartilage abnormalities are already present following initial ACL injuries over the lateral tibia. Quantitative MRI can allow critical evaluation of medical and surgical treatments for ligament and degenerative conditions of the knee.

Bolbos, Radu I.; Ma, C. Benjamin; Link, Thomas M.; Majumdar, Sharmila; Li, Xiaojuan

2010-01-01

376

Three-dimensional dynamic motion analysis of the anterior cruciate ligament deficient knee joint  

Microsoft Academic Search

Dynamic three-dimensional motion analyses of 15 fresh human knee joints subjected to combinations of flexion velocity and moment, internal and external femoral torque, and horizontal shear before and after sectioning the ACL were performed. ACL deficient specimens demonstrated marked anterior instability without rota tional instability. The pivot shift phenomenon occurred with an isolated ACL deficiency and was the result of

Jeffrey D. Reuben; Joshua S. Rovick; Robert J. Schrager; Peter S. Walker; Arthur L. Boland

1989-01-01

377

Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up  

PubMed Central

The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1–T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25–100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis.

Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schuttler, Karl Friedrich; Ziring, Ewgeni

2012-01-01

378

Arthroscopic repair of a chondrolabral lesion associated with anterior glenohumeral dislocation.  

PubMed

Chondrolabral lesions are uncommon after anteroinferior glenohumeral dislocations. This report describes a new dual-lesion complex that involved an avulsion of the anteroinferior glenoid labrum and a flap tear of the adjacent articular cartilage [glenoid labral tear and articular cartilage flap (GLAF) lesion]. The chondral component involved a large undermined region of the anterior half of the lower glenoid articular cartilage, and the labral component involved an avulsion from the 2.30-6 o'clock position on the glenoid. The labral tear was reconstructed with 3 suture anchors to form a neo-labrum in an attempt to overlap and stabilize the periphery of the chondral flap. A meniscal repair device was used to place a mattress stitch in the cartilage periphery to further stabilize the flap. This technique resulted in a secure repair without any chondral damage, and this remained intact on an MRI performed at a 3-month follow-up. A final 12-month follow-up showed complete recovery, as assessed by the Oxford shoulder instability score and Rowe score, and by a return to the pre-injury sporting level. PMID:20221586

Page, Richard; Bhatia, Deepak N

2010-12-01

379

Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament.  

PubMed

During flexion of the intact knee, we measured the changes in distance between possible tibial and femoral attachments of an intraarticular ACL substitute. The change in distance during motion was described by the difference between the longest and shortest distances measured. Using knees from eight cadaver donors, we studied the effects of varying tibial and femoral attachment locations, applying anterior and posterior forces, and altering the range of flexion. We found that altering the femoral attachment had a much larger effect than had altering the tibial attachment. No femoral attachments were completely isometric. Femoral attachments that produced the smallest change in tibiofemoral distance, 2 mm and less, formed a band whose greatest width ranged from 3 to 5 mm. The axis of the 2 mm region was nearly proximal-distal in orientation and located near the center of the ACL's femoral insertion. Attachments located anterior to the axis moved away from the tibial attachment with flexion, whereas attachments located posterior to the axis moved toward the tibia. The AP position of the tibial attachment affected the orientation of the 2 mm region. Moving the tibial attachment posteriorly caused the proximal part of the region to move anterior, with little change in the location of the distal part of the region. Changing the applied joint force from anterior to posterior was similar to moving the tibial attachment posteriorly, but the effect was less pronounced. Increasing the range of flexion from 90 degrees to 120 degrees caused the 2 mm region to become narrower and changed its orientation. PMID:2667378

Hefzy, M S; Grood, E S; Noyes, F R

1989-01-01

380

The Human Posterior Cruciate Ligament Complex: An Interdisciplinary StudyLigament Morphology and Biomechanical Evaluation  

Microsoft Academic Search

To study the structural and functional properties of the human posterior cruciate ligament complex, we meas ured the cross-sectional shape and area of the anterior cruciate, posterior cruciate, and meniscofemoral liga ments in eight cadaveric knees. The posterior cruciate ligament increased in cross-sectional area from tibia to femur, and the anterior cruciate ligament area de creased from tibia to femur.

Christopher D. Harner; John W. Xerogeanes; Glen A. Livesay; Gregory J. Carlin; Brian A. Smith; Takeshi Kusayama; Shinji Kashiwaguchi; Savio L.-Y. Woo

1995-01-01

381

Eight clinical conundrums relating to anterior cruciate ligament (ACL) injury in sport: recent evidence and a personal reflection.  

PubMed

Over two million anterior cruciate ligament (ACL) injuries occur worldwide annually, and the greater prevalence for ACL injury in young female athletes is one of the major problems in sports medicine. Optimal treatment of ACL injury requires individualised management. Patient selection is of utmost importance, and so is respect for the patient's functional demands and interests. All patients with an ACL tear may not need surgery, however athletes and persons with an active lifestyle with high knee functional demands including cutting motions need and should be offered surgery. In many cases it may not be the choice of graft or technique that is the key for success, but the choice of surgeon. The surgeon should be experienced and use a reconstructive procedure he/she knows very well and is comfortable with. The development of osteoarthritis after an ACL injury depends very much on the injury mechanism and concurrent meniscal injury, as knee articular cartilage continues to heal for 1-2 years after an ACL injury. Therefore the surgeon and rehabilitation team must pay attention to the rehabilitation process and to the decision when to return to sport. Return to sport must be carefully considered, as top-level sport in itself is one main risk factor for osteoarthritis after ACL injury. The present criteria for return to sport need to be revisited, also due to the fact that recurrent injury seems to be an increasing problem. ACL injury prevention programmes are now available in some sports. The key issue for a prevention programme to be successful is proper implementation. Vital factors for success include the individual coaching of the player and well controlled compliance with the training programme. Preventive activities should be more actively supported by the involved athletic community. Despite substantial advances in the field of ACL injury over the past 40 years, substantial management challenges remain. PMID:22942168

Renström, Per A

2013-04-01

382

[Accurate placement of bone tunnels in reconstruction of the anterior cruciate ligament - a contribution of computer-assisted navigation].  

PubMed

Rupture of the anterior cruciate ligament (ACL) is one of the most frequent injuries to the knee joint in the young. ACL repair is a major orthopedic procedure most often performed in the younger adult population. Early stabilization of the knee joint by ACL reconstruction also decreases the risk of injury to other important structures. At ACL reconstruction, the biggest problem is usually the exact placement of drilled tunnels. This significantly affects the outcome of surgery, i. e., range of motion, knee joint stability, reaction of the synovium in the knee, pain, impingement and potential graft failure with lesion development. However, 70 % of ACL reconstructions are carried out by orthopedic surgeons whose experience is limited to less than 20 ACL repair procedures in a year! Arthroscopy does not allow the surgeon to gain a complete 3D view of important anatomical structures, particularly in the anteroposterior direction. Computer-assisted navigation systems should aid in minimizing these problems. First reports on the use of computer-assisted navigation in ACL reconstruction, which have already been published in the international literature, have provided clear evidence that more exact bone tunnel placement can be achieved with navigation than with the use of conventional techniques. In addition, kinematic navigation enables us to measure anteroposterior and rotational knee stability, isometry, impingement and the angles of bone tunnel placement. It permits a choice from various types of graft. Last but not least, kinematic navigation provides a tool for recording surgery outcomes without a necessity to use further examination methods. Its drawbacks, namely, the learning curve, additional fixation of navigation probes to the femur and tibia and slightly longer operative time, should be considered in the context of presumed long-term benefits for the patient. PMID:17493414

Hart, R; Krejzla, J; Sváb, P

2007-04-01

383

Effectiveness of three extraction techniques in the development of a decellularized bone-anterior cruciate ligament-bone graft.  

PubMed

In this study, porcine bone-anterior cruciate ligament-bone (B-ACL-B) grafts were decellularized using one of three protocols incorporating surfactants lauryl sulfate (SDS), Triton X-100, and/or an organic solvent (tributyl phosphate (TnBP)). The effectiveness of Triton-SDS, Triton-Triton or Triton-TnBP treatments in removing cellular materials was determined and possible changes in biochemical composition and mechanical properties due to each treatment were investigated. Treatment with Triton-SDS was most effective at removing cell nuclei and intracellular protein (vimentin) from the ACL but affected both the collagen and glycosaminoglycan (GAG) components of the extracellular matrix while increasing the tensile stiffness of the ligament. Triton-Triton was the least effective of the three treatments in terms of cellular extraction, but did not significantly change the mechanical and biochemical properties of the ACL. Triton-TnBP matched the level of decellularization achieved by Triton-SDS in terms of visible cell nuclei; however, the extraction of intracellular vimentin was less consistent. TnBP treatment also slightly decreased the collagen content of the ACL but did not alter its mechanical properties. Overall, all three decellularization treatments maintained adequate mechanical and biochemical properties of B-ACL-B grafts to justify the further investigation of all three decellularization protocols. The selection of a superior treatment will depend on future studies of the propensity of treated tissues for repopulation by host ACL fibroblasts and, ultimately, on any immunogenic and/or remodeling host response induced in vivo. PMID:16023194

Woods, Terence; Gratzer, Paul F

2005-12-01

384

Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction  

NASA Astrophysics Data System (ADS)

Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy density (SED) distribution after the anatomic single-bundleACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw.

Yao, Jie; Kuang, Guan-Ming; Wong, DuoWai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

2014-03-01

385

Does Lateral Knee Geometry Influence Bone Bruise Patterns after Anterior Cruciate Ligament Injury? A Report of two Cases  

PubMed Central

Bone bruise patterns are commonly seen after acute anterior cruciate ligament injuries; they represent a subchondral impaction injury that occurs in the lateral knee joint between the mid-lateral femoral condyle and the posterior lateral tibial plateau. These contusion patterns are present in the majority of noncontact ACL injuries. These injury patterns vary significantly in severity and this aspect is poorly understood. Edema patterns have gained increased interest in the literature of late; they may indicate the severity of the initial injury. They also may be correlated with the development of subsequent osteochondral defects and osteoarthritis. Given the location of this subchondral injury, it is plausible to assume that the geometry of the lateral femorotibial joint may play a role in ACL injury mechanism and severity of injury. We are reporting two cases of clinically identical ACL injuries. A patient with a flat lateral tibial plateau was noted to have a much larger bone edema pattern than a second patient with the highly convex lateral tibial plateau. This may shed light on the pathomechanics of ACL injury and suggests that an individual with a relatively flat tibial plateau has a stable lateral knee joint. Therefore, we hypothesize that much greater force is required to dislocate a flat and stable lateral femorotibial joint in a pivot shift pattern to produce an ACL injury. The greater force required results in a large bone edema pattern. Conversely, the individual with a relatively short and convex tibial plateau has an inherently unstable lateral joint and relatively smaller amounts of force would be needed to produce the identical injury to the ACL. As less force is required, smaller bone edema patterns result.

Westermann, Robert W; Wolf, Brian R; Wahl, Christopher J

2013-01-01

386

Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction  

NASA Astrophysics Data System (ADS)

Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy den sity (SED) distribution after the anatomic single-bundle ACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9 mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw. [Figure not available: see fulltext.

Yao, Jie; Kuang, Guan-Ming; Wong, Duo Wai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

2014-04-01

387

Comparative in vivo study of injectable biomaterials combined with BMP for enhancing tendon graft osteointegration for anterior cruciate ligament reconstruction.  

PubMed

This study was to compare effect of osteointegration of grafted tendon in bone tunnels between injected calcium phosphate cement (ICPC) and injected fibrin sealant (IFS) combined with bone morphogenetic protein (BMP) after anterior cruciate ligament (ACL) reconstruction. ACL reconstruction was performed bilaterally in 51 rabbits. ICPC-BMP composite was injected into one knee, with the contralateral knee IFS-BMP composite. The rabbits were killed at postoperative weeks 2, 6, and 12 for testing. Histological observations showed the ICPC composite gradually increased the new bone formation during the whole healing process, while the IFS composite had a burst effect on enhancing the healing of tendon-to-bone at 2 and 6 weeks. By 12 weeks, there was more new cartilage and new bone in the interface in the ICPC-bBMP group. Micro-CT showed that the values of BMD in the ICPC-bBMP group were lower than those in the IFS-bBMP group at 6 weeks, while the values in the ICPC-bBMP group were higher than those in the IFS-bBMP group at 12 weeks (p?>?0.05). Fluorescent labels showed that the rate of new bone formation of IFS-BMP composite was significantly higher than that of ICPC composite at 6 weeks (3.45?±?0.62?µm/day vs. 2.93?±?0.51?µm/day), but the rate was decreased compared with ICPC composite at 12 weeks (2.58?±?0.72?µm/day vs. 3.05?±?0.68?µm/day; p?

Pan, Weimin; Wei, Yiyong; Zhou, Li; Li, Dan

2011-07-01

388

Comparison of transtibial and transportal techniques in drilling femoral tunnels during anterior cruciate ligament reconstruction using 3D-CAD models  

PubMed Central

Purpose The purpose of this study was to assess the differences in bone tunnel apertures between the trans-accessory medial portal (trans-AMP) technique and the transtibial (TT) technique in double-bundle anterior cruciate ligament reconstruction. The extent of ovalization and the frequency of overlap of the two tunnel apertures were compared. Methods The simulation of femoral tunnel drilling with the TT and the trans-AMP techniques was performed using three-dimensional computer aided design models from two volunteers. The incidence angle of drilling against the intercondylar wall, the femoral tunnel position, the ovalization, and the overlap were analyzed. The aperture and location of the tunnels were also examined in real anterior cruciate ligament reconstruction cases (n=36). Results The surgical simulation showed that a lower drill incident angle induced by the TT technique made the apertures of two tunnels more ovalized, located anteromedial tunnels in a shallower position to prevent posterior wall blow out, and led to a higher frequency of tunnel overlap. The trans-AMP group had tunnel places within the footprint and had less ovalization and overlap. The results of analysis for tunnels in the clinical cases were consistent with results from the surgical simulation. Conclusion In the TT technique, the shallow anteromedial tunnel location and more ovalized tunnel aperture can lead to a higher frequency of tunnel overlap. Compared with the TT technique, the trans-AMP technique was more useful in preparing femoral tunnels anatomically and avoiding tunnel ovalization and overlapping in double-bundle anterior cruciate ligament reconstruction.

Tashiro, Yasutaka; Okazaki, Ken; Uemura, Munenori; Toyoda, Kazutaka; Osaki, Kanji; Matsubara, Hirokazu; Hashizume, Makoto; Iwamoto, Yukihide

2014-01-01

389

In Vivo Motion of Femoral Condyles During Weight-Bearing Flexion After Anterior Cruciate Ligament Rupture Using Biplane Radiography  

PubMed Central

The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key Points Three-dimensional tibiofemoral kinematics and femoral condylar motion in ACL-deficient knees during upright weight-bearing flexion were measured using biplane radiography with the geometric center axis. ACL deficiency caused posterior subluxation of the lateral condyle with excess external femoral rotation at early flexion positions. On flexion from 15° to 60°, the lateral condyle moved slightly posteriorly in ACL deficiency leading to reduced extent of external femoral rotation.

Chen, Kaining; Yin, Li; Cheng, Liangjun; Li, Chuan; Chen, Cheng; Yang, Liu

2013-01-01

390

Outcome and knee-related quality of life after anterior cruciate ligament reconstruction: a long-term follow-up.  

PubMed

The aim of the present investigation was to study patient-reported long-term outcome after anterior cruciate ligament (ACL) reconstruction. On an average 11.5 years after ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft 56 patients were asked to answer four different questionnaires about their knee function and knee-related quality of life. Another aim was to study whether there were any correlations between clinical tests, commonly used for evaluating patients with ACL injuries, which were performed 2 years after ACL reconstruction, and patient-reported outcome in terms of knee function and knee-related quality of life on an average 9.5 years later. All patients who had unilateral BPTB ACL reconstructions were examined at 2 years and on an average 11.5 years after surgery. At 2 years one-leg hop test for distance, isokinetic muscle torque measurement, sagittal knee laxity, Lysholm knee scoring scale and Tegner activity scale were used for clinical evaluation. At the follow-up on an average 9.5 years later the patients were evaluated with knee injury osteoarthritis outcome score (KOOS), short form health survey (SF 36), Lysholm knee scoring scale and Tegner activity scale. The SF-36 showed that the patients had a similar health condition as an age- and gender-matched normal population in Sweden on an average 11.5 years after ACL reconstruction. There was no correlation between the results of one-leg hop test for distance, isokinetic muscle torque measurement, sagittal knee laxity evaluated 2 years after surgery and the result of KOOS (function in sport and recreation, knee-related quality of life) and SF-36 evaluated on an average 11.5 years after surgery. We also compared patients that 2 years after surgery demonstrated a side-to-side difference in anterior-posterior knee laxity of more than 3 mm with those with 3 mm or less and found no significant group differences in terms of knee function as determined with KOOS. We found no correlation between the results of KOOS and SF-36 at the long-term follow-up and the time between injury and surgery, age at surgery or gender, respectively. We conclude that there is no correlation between patient-reported knee function in sport and recreation and knee-related quality of life on an average 11.5 years after BPTP ACL reconstruction and the evaluation methods used 2 years after surgery. PMID:19360401

Möller, Eva; Weidenhielm, Lars; Werner, Suzanne

2009-07-01

391

A biomechanical analysis of anterior cruciate ligament reconstruction with the patellar tendon. A two year followup.  

PubMed

Eleven patients, 2 years after ACL reconstruction with a patellar tendon graft, returned for follow-up testing consisting of: 1) subjective assessment and functional analysis, 2) objective examination for residual ligamentous instability, 3) isokinetic quadriceps and hamstrings strength assessment, 4) radiographic assessment, 5) instrumented measurement of anterior shear displacement via a knee arthrometer, and 6) force plate and film analysis while performing cutting maneuvers in a laboratory setting. All 11 patients had been tested preoperatively through all steps except the fifth. The group subjectively rated the postoperative knee as 83% of the preinjury status, an increase from a 53% mean prior to reconstruction. Six of 11 patients were able to return to their full preinjury level of competition, with or without a brace. Four patients had positive drawer tests, five had positive Lachman examinations, and all subjects had negative pivot shifts. Significant quadriceps torque deficits remained (P less than 0.0005), with the postoperative knee extensors approximately 85% of the contralateral limb. The involved limb hamstrings were equal in strength to the nonoperated limb. Radiographic evaluation revealed four, five, and four patients with positive findings of the patellofemoral joint, medial joint space, and lateral joint space, respectively. Only one patient had normal radiographs. Instrumented knee laxity testing revealed the operated knee to be significantly looser only during maximum passive displacement (7.2 mm versus 5.3 mm, P less than 0.01) and not during the other measurements. Biomechanical analysis of the straight cut maneuver revealed no significant differences between the nonoperated and operated limbs at the 2 year postoperative mark.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3189654

Tibone, J E; Antich, T J

1988-01-01

392

Clinical Outcomes and Return-to-Sports Participation of 50 Soccer Players After Anterior Cruciate Ligament Reconstruction Through a Sport-Specific Rehabilitation Protocol  

PubMed Central

Background: Rehabilitation of soccer players after anterior cruciate ligament reconstruction is usually performed without sport-specific guidelines, and the final phases are often left to the team coaches. The possibility of changing this approach has not yet been investigated. Study Design: Case series. Hypothesis: A specific rehabilitation protocol for soccer players, with direct control of the last on-field rehabilitation phases, may lead to complete functional recovery. Methods: Fifty competitive soccer players who followed a sport-specific rehabilitation protocol for soccer were evaluated during the recovery period until their return to competition. The assessment of the functional outcomes was performed using the Knee Outcome Survey–Sports Activity Scale and isokinetic and aerobic fitness tests. Results: The average start of on-field rehabilitation was 90 ± 26 days after surgery; the average time to return to the competitions was 185 ± 52 days. The improvement in the Knee Outcome Survey–Sports Activity Scale during on-field rehabilitation was significant (P < 0.01; from 79 ± 15% to 96 ± 7%). The isokinetic and aerobic fitness tests showed a significant improvement of muscle strength (knee extensors, +55%, P < 0.01; knee flexors, +86%, P < 0.01) and aerobic threshold (+23%, P < 0.01) from the beginning to the end of on-field rehabilitation. Conclusions: Adding on-field rehabilitation to the traditional protocols after anterior cruciate ligament reconstruction may safely lead to complete functional recovery in soccer players.

Della Villa, Stefano; Boldrini, Lorenzo; Ricci, Margherita; Danelon, Furio; Snyder-Mackler, Lynn; Nanni, Gianni; Roi, Giulio Sergio

2012-01-01

393

The influence of electromyographic biofeedback therapy on knee extension following anterior cruciate ligament reconstruction: a randomized controlled trial  

PubMed Central

Background Loss of knee extension and a deficit in quadriceps strength are frequently found following anterior cruciate ligament (ACL) reconstruction. The aim of this study was to investigate whether the addition of Eletromyographic Biofeedback (EMG BFB) therapy for the vastus medialis muscle to the in the early phase of the standard rehabilitation programme could improve the range of knee extension and strength after ACL reconstruction more than a standard rehabilitation programme. The correlation between EMG measurement and passive knee extension was also investigated. Method Sixteen patients, all of whom underwent endoscopic ACL reconstruction using patellar tendon autograft, were randomly assigned to two groups: • Control group (8 patients): standard rehabilitation protocol; with full weight-bearing postoperative, knee brace (0° extension, 90° flexion), electrical stimulation, aquatics and proprioceptive training. • The EMG BFB group (8 patients): EMG BFB was added to the standard rehabilitation protocol within the first postoperative week and during each session for the next 6 weeks. Each patent attended a total of 16 outpatient physiotherapy sessions following surgery. High-Heel-Distance (HHD) Test, range of motion (ROM) and integrated EMG (iEMG) for vastus medialis were measured preoperatively, and at the 1, 2, 4 and 6-week follow ups. Additionally, knee function, swelling and pain were evaluated using standardized scoring scales. Results At 6 weeks, passive knee extension (p??0.01) differences were found between the two groups for the assessment of knee function, swelling and pain. Conclusion The results indicate that EMG BFB therapy, in the early phase of rehabilitation after ACL reconstruction, is useful in enhancing knee extension. Improved innervation of the vastus medialis can play a key role in the development of postoperative knee extension. EMG BFB therapy is a simple, inexpensive and valuable adjunct to conventional therapeutic modalities.

2012-01-01

394

Is there a potential relationship between prior hamstring strain injury and increased risk for future anterior cruciate ligament injury?  

PubMed

Hamstring strain injuries (HSIs) are the most prevalent injury in a number of sports, and while anterior cruciate ligament (ACL) injuries are less common, they are far more severe and have long-term implications, such as an increased risk of developing osteoarthritis later in life. Given the high incidence and severity of these injuries, they are key targets of injury preventive programs in elite sport. Evidence has shown that a previous severe knee injury (including ACL injury) increases the risk of HSI; however, whether the functional deficits that occur after HSI result in an increased risk of ACL injury has yet to be considered. In this clinical commentary, we present evidence that suggests that the link between previous HSI and increased risk of ACL injury requires further investigation by drawing parallels between deficits in hamstring function after HSI and in women athletes, who are more prone to ACL injury than men athletes. Comparisons between the neuromuscular function of the male and female hamstring has shown that women display lower hamstring-to-quadriceps strength ratios during isokinetic knee flexion and extension, increased activation of the quadriceps compared with the hamstrings during a stop-jump landing task, a greater time required to reach maximal isokinetic hamstring torque, and lower integrated myoelectrical hamstring activity during a sidestep cutting maneuver. Somewhat similarly, in athletes with a history of HSI, the previously injured limb, compared with the uninjured limb, displays lower eccentric knee flexor strength, a lower hamstrings-to-quadriceps strength ratio, lower voluntary myoelectrical activity during maximal knee flexor eccentric contraction, a lower knee flexor eccentric rate of torque development, and lower voluntary myoelectrical activity during the initial portion of eccentric contraction. Given that the medial and lateral hamstrings have different actions at the knee joint in the coronal plane, which hamstring head is previously injured might also be expected to influence the likelihood of future ACL. Whether the deficits in function after HSI, as seen in laboratory-based studies, translate to deficits in hamstring function during typical injurious tasks for ACL injury has yet to be determined but should be a consideration for future work. PMID:24121082

Opar, David A; Serpell, Benjamin G

2014-02-01

395

No difference at two years between all inside transtibial technique and traditional transtibial technique in anterior cruciate ligament reconstruction  

PubMed Central

Summary Background: one of the most recent technique is the “all inside” anterior cruciate ligament (ACL) reconstruction. One of the main characteristic of this procedure is the sparing of the tibial cortex. Furthermore, the all-inside technique requires only one tendon harvested. Purpose: the present study describes two year clinical outcomes of the all-inside method for ACL reconstruction, and compares them with clinical results of a group of patients treated with the traditional transtibial single-bundle ACL reconstruction technique using the semitendinosus and gracilis tendons (ST-G). Study design: pilot study, using historical controls. Methods: ACL reconstruction was performed on two groups of 20 patients each. The patients in one group underwent the all-inside transtibial technique with ST tendon alone. The second group underwent ACL reconstruction with the traditional transtibial single-bundle procedure using quadrupled ST-G tendons. Follow up at 24 months was undertaken using the IKDC, VAS pain score, Lysholm and Tegner scales. Results: the VAS pain score for the traditional ACL group was 84.6 ± 12.6; whereas the score for the all-inside group was 81.6 ± 13.1, with no statistically significant differences between the two groups. In the traditional ACL reconstruction group the Lysholm scale gave a “good results” for 7 patient (35%) and “excellent results” for 13 patients (65%) and the all-inside group gave “sufficient